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AHCCCS has requested we pass this important message along to our provider network. Based on many questions AHCCCS has received regarding submitting encounters with CPT codes and provider types that are non-covered by Medicare for dual eligible members, the claim should be submitted as follows:
Historically providers and Health Plans have struggled with the coordination of benefits for dual members when Medicaid covered services do not qualify for Medicare and Medicare primary payment or when a Medicaid allowable provider type is not recognized by Medicare. In these cases Medicare does not issue a denial or explanation of benefits.
To relieve significant provider concern, administrative burden, and related costs to providers, AHCCCS is allowing the Providers to zero (0) fill the Medicare payment as non-covered for these services (indicating no payment by Medicare) on the claim, when Medicare guidelines are not met.
Adopting this practice will ensure the encounter do not deny for edit errors R280 – Medicare coverage indicated but not billed or/and R600 Medicare Coverage Indicated but Not Billed.
As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this Notice and all other provider notices on our Mercy Care website.
Thanks for all you do!
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