RCPA - Rehabilitation and Community Providers Association


MAMIS Remittance Advice Alert
March 25, 2001

The Office of Medical Assistance Programs has released the following information regarding incorrectly rejected claims during Billing Cycles 39 & 40 by the Provider Types 41 & 50. Additional information about the incorrectly rejected claims should be addressed to the Provider Liaison identified by the Office of Medical Assistance Programs.

The Department has identified claims that were incorrectly rejected on Remittance Advice Cycles 32 through 38 on Edit 278 (The procedure/Drug NDC code requires Prior Authorization or Prior Approval and the Prior Authorization or Prior Approval number is missing). The Department will be resubmitting these claims through the system and they will appear on Cycle 40. If you have already identified and resubmitted these claims, they will appear rejected as duplicate claims on this remittance advice. Please note that if there are other errors on these invoices, they will reject on other edits.

It is obvious from reviewing some of the other rejected claims for TSS that there is confusion about matching the procedure code and modifier with the proper approval number. For TSS services approved prior to 03/01/01 through the 1150 Administrative Waiver Process (Program Exception), providers should use the Program Exception Authorization Number, procedure code and modifier found on the Program Exception Notice.For any claim submission, make sure that you match the procedure code and modifier with its associated approval number.

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