Top Written Inquiries FAQs
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The following are FAQs that WPS Medicare publishes based upon topics we identify as generating a high volume of written inquiries to Customer Service. We hope the answers to the questions listed below assist you in reducing the need to write Customer Service and claim errors associated with these topics.
- What are the top reasons providers and their agents wrote the WPS Medicare Provider Contact Center during the previous quarter?
- I need to submit a claim for which Medicare is the third payer. How do I submit a tertiary claim to Medicare when our facility is required to file all claims electronically and my software does not allow me to file tertiary claims?
- After reviewing one of your policies, I think WPS Medicare should consider adding additional covered diagnosis codes to the Local Coverage Determination (LCD). How can I request changes to a published WPS Medicare Local Coverage Determination (LCD)?
- How long do we have to submit a claim?
- What documentation is required when submitting Not Otherwise Classified (NOC) Health Care Procedure Coding System (HCPCS) code J3490?
- I disagree with Medicare's decision on my redetermination. How can I get Medicare to look at my documentation again?
- I read on your website providers can access duplicate remittance notices through C-SNAP, but I am not sure how to obtain them. Are there specific instructions I can review?
What are the top reasons providers and their agents wrote the WPS Medicare Provider Contact Center during the previous quarter?
The following table lists the top reasons, by topic, for which our Medicare providers and their agents sent in a written inquiry during the previous quarter (December 2011 through February 2012). This list excludes claim status and eligibility inquiries.
Description Occurrences Appeals, Process Rights
Note: This figure represents the number of redetermination requests submitted for claims that do not have appeal rights.1,938 General Information, Misrouted Telephone Call/Written Correspondence 230 Appeals, Status/Explanation/Resolution 71 Remittance Advice, Duplicate Remittance Notice 69 Claim Denial, Coding Errors/Modifiers 68 General Information, Issue Not Identified/Incomplete Information Provided 68 Policy/Coverage Rules, Benefits/Exclusion/Coverage Criteria/Rules 51 Administrative Billing Issues, Filing/Billing Instructions 41 General Information, Other Issues 39 Claim Denial, Contractual Obligation Not Met 36 I need to submit a claim for which Medicare is the third payer. How do I submit a tertiary claim to Medicare when our facility is required to file all claims electronically and my software does not allow me to file tertiary claims?
WPS Medicare is aware that our electronic claims software does not allow tertiary claims to be submitted. In order to have your claim processed, please submit a paper claim to Medicare and include copies of all insurers' Explanation of Benefits. When submitting your claim please include the statement "tertiary claim" in Item 19 of the claim form.
After reviewing one of your policies, I think WPS Medicare should consider adding additional covered diagnosis codes to the Local Coverage Determination (LCD). How can I request changes to a published WPS Medicare Local Coverage Determination (LCD)?
WPS Medicare currently has a process in place, the WPS Medicare LCD Reconsideration Process, where interested parties can request a revision to a finalized LCD. This process includes adding additional covered diagnosis codes to an LCD. For information regarding the LCD Reconsideration Process, please access the information provided on the WPS Medicare website.
How long do we have to submit a claim?
A one-year timely filing requirement was implemented based on The Patient Protection and Affordable Care Act (PPACA), which President Obama signed into law on March 23, 2010. Therefore, providers have one year from the date of service to submit a claim. These requirements apply when Medicare is primary or secondary. Please see our website for more information about timely filing.
What documentation is required when submitting Not Otherwise Classified (NOC) Health Care Procedure Coding System (HCPCS) code J3490?
In order for WPS Medicare to correctly reimburse NOC J3490, providers must indicate the following in the electronic narrative, line level 2400 loop NTE segment, or in Item 19 of CMS-1500 claim form:
- The name of the drug,
- The total dosage (plus strength of dosage, if appropriate), and
- The method of administration, and
- List the units of service as one in 2400/SV1-04 data element of the ANSI 837 5010 or in item 24G of the CMS-1500 claim form.
I disagree with Medicare's decision on my redetermination. How can I get Medicare to look at my documentation again?
Medicare contractors cannot perform more than one redetermination on any service. If a provider disagrees with a redetermination decision, the next level of appeal would be reconsideration (Second Level of Appeal) through the Qualified Independent Contractor (QIC). There is no minimum dollar amount required for requesting a reconsideration. The request for reconsideration must be filed within 180 days of the redetermination decision date. Reconsideration requests may be submitted on the CMS Form 20033Adobe Portable Document Format. Additional information about the reconsideration process can be found on our website.
I read on your website providers can access duplicate remittance notices through C-SNAP, but I am not sure how to obtain them. Are there specific instructions I can review?
Our C-SNAP On Demand Training series provides education on a variety of subjects, including the viewing and printing of duplicate remittance notices through C-SNAP. You may access this training on our website by selecting the link for "C-SNAP Real Time Claim Status and Duplicate Remittance Advice."
Page Last Updated: Monday, 14-May-2012 12:29:46 CDT
