Submitting Appeals on C-SNAP
Providers who submit claims for services performed in Illinois, Michigan, Minnesota, or Wisconsin have the ability to submit an appeal through the Centers for Medicare & Medicaid Services (CMS) Secure Net Access Portal (C-SNAP). Recently, Wisconsin Physicians Service (WPS) Medicare has noticed an increase in the submission of C-SNAP appeals for services provided in other states, including Iowa, Kansas, Nebraska, and Missouri. WPS Medicare cannot accept J5 appeal requests submitted through C-SNAP.
If you have submitted a C-SNAP appeal for services provided outside Illinois, Michigan, Minnesota, or Wisconsin, you must send the appeal to the appropriate address for the state in which the service was provided. WPS will not be waiving timely filing for J5 redetermination requests, which were inappropriately submitted through C-SNAP. To obtain the correct address for a claim processed by WPS Medicare claims in Iowa, Kansas, Nebraska, and Missouri visit the WPS Medicare Website and use the address for the state the services were provided in.
A few tips for our C-SNAP providers who fax information electronically to us...
WPS Medicare often receives extensive documentation, in an effort to ensure that WPS receives all faxed documentation WPS asks that you submit appeal requests that are 20 pages or more by mail. Please keep in mind that occasionally, the information submitted is not required to adjudicate the case.
- For example, if a claim is denied for medical necessity, please review your claim to determine if the denial is due to the diagnosis code billed or due to the frequency of the service. The documentation needed may only be a new diagnosis code. Please check the Medicare Policy for covered diagnosis codes and documentation submission requirements.
- Please check that the documentation is for the date of service and the beneficiary that is on the claim that denied.
- When sending documentation, clearly indicate the section of the documentation that supports your opinion that the claim should not have denied. This should be stated on the redetermination request form, in the section "I do not agree with the determination of my claim. MY REASONS ARE:" or in the section "Additional Information Medicare Should Consider"
- Appeals for services which have a "B", "I" or "N" status indicator on the Medicare Fee Schedule database are services which are always bundled or invalid for Medicare. The addition of a modifier with medical documentation will not enable Medicare to make a payment on appeal. To make payment, the fee schedule indicator for the code would need to be changed by CMS.
- Also, check CCI edits to ensure that modifiers can be applied to unbundle services. If the CCI indicator is "0" for a particular code pair, again, the addition of a modifier and notes on appeal will not cause Medicare to reverse the initial determination. In this situation, the CCI edit would need to be revised before Medicare could make payment.
Page Last Updated: Thursday, 18-Mar-2010 05:54:42 CDT
