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CCS SAR Problems
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CAMPS has been in discussions with ACS and CCS over continued provider problems when submitting CCS claims with multiple units on the SAR. Providers were getting denials on some claims indicating that there were no units available or some claim lines would pay but other deny for lack of available SAR units. It was clear that the SAR units were not always being found in the claims processing system or the units were not decrementing correctly.
The problem was acknowledged several weeks ago but it took some time for ACS and DHCS staff to actually identify the cause. We are told that the problem began on 10/15/11 and may involve up to 75,000 claims. There is no consistency as to when and if it would happen to a particular CCS claim. They will have identified all the claims involved by the end of this week. You need to know the following:
- The fix to accurately determine the number of SAR units is not yet complete, meaning that you may still see denials this week.
- DHCS will authorize an Electronic Payment Correction (EPC) that will identify and reprocess all claims that were incorrectly denied. The date for when that EPC will be activated is not yet established but we will let you know when it is set to run
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Medi-Cal 10% Repayment
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There is no date yet to report on the Erroneous Payment Corrections (EPCs) that will return to providers the 10% payment reductions that occurred between the issuance of the injunction on 1/30/12 and when the correct pricing was re-instituted. The restoration of the correct pricing depended on the specific procedure code and appeared to not be totally corrected for all DME and supplies until late April or even early May. Once the EPC is scheduled we will alert our members. |
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One Capitol Mall, Suite 320
Sacramento, CA 95814 t: (916) 443-2115 f: (916) 444-7462 |
