Release Newsletter
Version 1.92
April 2008
Institutional
Change Summary
We are pleased to announce the release of PC-ACE Pro32
version 1.92. This upgrade contains
several CMS Medicare Mandates and product enhancements effective 4/1/2008,
including these highlighted changes:
¨ New HCPCS Modifiers When Billing Patient Care in Clinical Research Edits implemented to support new clinical service Modifiers
¨ CR5790 8-Digit Clinical Trial Number - Several changes made in support of the 8-digit Clinical Trial Number
ENCLOSED
Materials
¨ Pre-built PC-ACE Pro32 1.92 upgrade file named PCACEUP.EXE and replacement SETUP.EXE file for any new providers
¨ This Newsletter
CMS
Medicare Mandates
CR5805 New HCPCS Modifiers When
Billing Patient Care in Clinical Research Studies
ͺ Modified several
Institutional claim edits to allow reporting of new clinical service Modifiers
Q0 and Q1, which replace QA, QR and QV effective 1/1/2008.
CR5699 Reporting of Hematocrit
and/or Hemoglobin Levels on All Claims for Administration of Erythropoiesis
Stimulating Agents (ESAs) for Non-ESRD Indications and Implementation of New
Modifiers for Non-ESRD Indications
ͺ Added a new Institutional
claim edit requiring that either Value Code 48 or 49 be present on the claim
when one of the following HCPCS codes is present: J0881, J0882, J0885, J0886 or
Q4081 (eff. 1/1/2008 ; All TOBs except
72x).
ͺ Added a new Institutional
claim edit requiring that Modifier EA, EB or EC always be billed with non-ESRD
ESA HCPCS codes J0881 or J0885 (eff. 1/1/2008 ; All TOBs except 72x).
ͺ Added several Institutional
claim edits which prohibit reporting of more than one of the anemia quality
Modifiers EA, EB and EC on the same service line (eff. 1/1/2008).
ADDITIONAL CMS Mandated CHANGES
CR5850 Updated NUBC Codes and Other Internal only Manual Chapter 25 Revisions
ͺ Added an Institutional claim edit prohibiting the use of Revenue Code "0948 - Pulmonary Rehab" on all Medicare claims (effective 1/1/2008).
CR5790 Requirements for Including an 8-Digit Clinical
Trial Number on Claims
ͺ Modified the Institutional Claim form to automatically adjust the format of the 8-digit Clinical Trial Number associated with Value Code "D4" (CLINICAL TRIAL NUMBER ASSIGNED BY NLM/NIH) during hand-keying. Because of a width restriction on the Value Code Amount fields, this 8-digit value must be saved in 6+2 format (e.g., "123456.78"). However, it is desirable to allow the user to hand-key this as a simple 8-digit string with no decimal point entered. The claim form will now automatically reformat the 8-digit value into the required 6+2 format.
ͺ Added an Institutional claim edit
which requires that the amount entered for Value Code 'D4' (Clinical Trial
Number) be less than or equal to 999999.99 in order to enforce correct entry.
These 8-digit registry numbers are to be entered right justified, with
6-positions to the left of the decimal point.
ͺ Modified the Institutional Claim Print Module to omit the decimal point when printing the amount associated with Value Code "D4" (CLINICAL TRIAL NUMBER ASSIGNED BY NLM/NIH). The amount field for Value Code "D4" actually holds the 8-digit Clinical Trial Number rather than a currency value.
CR5938 Department of VA Claims Adjudication Services Project - New IOM Chapter - Pub. 100-04, Chapter 37 Department of VA Claims Adjudication Services Project
ͺ Modified several Institutional Claim edits and several Institutional Provider reference file edits to accept the special carrier-defined Veteran's Administration (VA) provider numbers. These provider numbers all have a "V" in the first position, and are billed on TOBs 11x, 12x, 13x, 14x and 18x.
NUBC UB-04 Manual (Version 2.00) Dated 12/5/2007
ͺ Added two new Value Codes
"FC - PATIENT PAID AMOUNT" and "FD - CREDIT RCVD FROM
MANUFACTURER FOR REPLACED MEDICAL DEVICE" (effective 7/1/2008). These new
Value Codes are active for all valid LOB/TOB combinations by default. Added a
non-fatal Institutional claim edit, which prohibits the use of these new Value
Codes prior to 7/1/2008.
ͺ Added the new
Patient Discharge Status code "70 - Discharged/transferred to another
Institution Type not Defined Elsewhere in this List" effective 4/1/2008.
This new code is a functional replacement for Patient Discharge Status code
"05" which has been redefined as "Discharged/transferred to a
Designated Cancer Center or Children's Hospital". Modified the fixed
lookup lists on this Institutional claim form field to reflect these changes.
Modified the field validation edit to allow the new code, and added a non-fatal
edit to restrict its use to on or after 4/1/2008.
Provider Taxonomy Code (Source: WPC)
ͺ Updated the Provider Taxonomy Code reference file with the latest WPC
published code set. Code Added: 5 ; Codes Deleted: 0 ; Codes Modified: 1. The
new codes are: "111NP0017X - Chiropractor : Pediatric Chiropractor",
"173C00000X - Reflexologist", "173F00000X - Sleep Specialist,
PhD", "1835P0018X - Pharmacist : Pharmacist Clinician (PhC)/ Clinical
Pharmacy Specialist", and "253J00000X - Foster Care Agency". The
modified code is: "207NS0135X - Dermatology : Procedural
Dermatology".
Claim Status Response Codes Update Source: WPC
ͺ Updated the Claim Status Response Codes reference file with the latest WPC published code set. Codes Added: Category - 0 , Status - 4 ; Codes Deleted: Category - 0 , Status - 0 ; Codes Modified: Category - 3 , Status - 17. The new status codes are: "685 - Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit.", "686 - The claim/ encounter has completed the adjudication cycle and the entire claim has been voided", "687 - Claim estimation can not be completed in real time. Do not resubmit." and "688 - Present on Admission Indicator for reported diagnosis code(s)". The modified category codes are: P2, P3 and P4. The modified status codes are: 4, 5, 7, 9, 21, 67, 68, 71, 112, 113, 114, 115, 283, 506, 585, 670 and 671.
Modifications in
Support of ANSI (HIPAA) IG Compliance
Other
HCPCS Update Source: CMS Website
ͺ Reinstated HCPS codes:
§
J7611
- ALBUTEROL NON-COMP CON
§
J7612
- LEVALBUTEROL NON-COMP CON
§
J7613
- ALBUTEROL NON-COMP UNIT
§
J7614
- LEVALBUTEROL NON-COMP UNIT
ͺ Added new HCPCS Codes
effective 4/1/2008
§
K0672
- REMOVE SOFT INTERFACE, REPL
§
Q4096
- VWF COMPLEX, NOT HUMATE-P
§
Q4097
- INJ IVIG PRIVIGEN 500 MG
§
Q4098
- INJ IRON DEXTRAN
§
Q4099
- FORMOTEROL FUMERATE, INH
§
S3628
- PAMG-1 RAPID ASSAY FOR ROM
Update to the Category I Codes Source: AMA Website
ͺ Added new HCPCS Codes
effective 4/1/2008
§
90650
- HPV TYP BIVAL 3 DOSE IM
§
90681
- ROTAVIRUS VACC 2 DOSE ORAL
§
90696
- DTAP-IPV VACC 406 YR IM
ͺ Added new HCPCS Codes
effective 7/1/2008
§
90738
- INACTIVATED JE VACC IM
Update to the Category II Codes Source: AMA Website
ͺ Added new HCPCS Codes
effective 1/1/2008
§
0525F
- INITIAL VISIT FOR EPISODE
§
0526F
- SUBS. VISIT FOR EPISODE
§
1130F
- BK PAIN + FXN ASSESSED
§
1134F
- EPSD BK PAIN FOR =< 6 WKS
§
1135F
- EPSD BK PAIN FOR > 6 WKS
§
1136F
- EPSD BK PAIN FOR <= 12 WKS
§
1137F
- EPSD BK PAIN FOR > 12 WKS
§
2044F
- DOC MNTL TST B/4 BK TRXMNT
§
4240F
- INSTR XRCZ 4BK PN >12 WEEKS
§
4242F
- SPRVSD XRCZ BK PN >12 WEEKS
§
4245F
- PT INSTR, RESUME NRML LIFEST
§
4248F
- PT INSTRNO BD REST>= 4 DAYS
§
4250F
- WRMNG 4 SURG - NORMOTHERMIA
§
5060F
- FNDNGS MAMMO 2PT W/IN 3 DAYS
§
5062F
- DOC F2FMAMMO FNDNG IN 3 DAYS
§
6040F
- APPRO RAD DS DVCS TECHS DOCD
§
6045F
- RADXPS IN END RPRT4FLURO PXD
§
7020F
- MAMMO ASSESS CAT IN DBASE
§
7025F
- PT INFOSYS ALARM 4 NXT MAMMO
ͺ Added new HCPCS Codes
effective 11/ 1/2007
§
2040F
- BK PN XM ON INIT VISIT DATE
§
3330F
- IMAGING STUDY ORDERED (BKP)
§
3331F
- BK IMAGING TST NOT ORDERED
ͺ Added new HCPCS Codes
effective 4/1/2008
§
3340F
- MAMMO ASSESS INC XRAY DOC'D
§
3341F
- MAMMO ASSESS "NEGATIVE.", DOC'D
§
3342F
- MAMMO ASSESS "BENGN", DOC'D
§
3343F
- MAMMO PROBABLYASSESS "?" BEN
§
3344F
- MAMMO ASSESS "SUSP", DOC'D
§
3345F
- MAMMO ASSESS "HGHLYMALIG DOC"
§
3350F
- MAMMO BX PROVEN MALIG DOC'D
ͺ Modified the description on
numerous Category II HCPCS codes to correct mostly punctuation errors.
Update to the Category III Codes Source: AMA Website
ͺ Added new HCPCS Codes
effective 7/1/2008
§
0188T
- VIDEOCONF CRIT CARE 74 MIN
§
0189T
- VIDEOCONF CRIT CARE ADDL 30
§
0190T
- PLACE INTRAOC RADIATION SRC
§
0191T
- INSERT ANT SEGMENT DRAIN INT
§
0192T
- INSERT ANT SEGMENT DRAIN EXT
Modifications to the Institutional Claim Form
ͺ Modified the Institutional claim form to add support for Reference Number types "23 - Client Number / Health Record Number", "IG - Insurance Policy Number", "SY - Social Security Number" and "Y4 - Property and Casualty Claim Number". These new reference numbers should be entered in the "Reference Number / Type" fields on the Institutional claim form's Extended Payer tab. Modified the claim import and prepare modules to import/report these reference numbers from/to the appropriate ANSI-837 loop/segment (REF/2010BA; REF*Y4/2010BA; REF*Y4/2010CA).
Claim Adjustment Reason Code (CARC) Reference File
Update Source: WPC
ͺ Updated the
Claim Adjustment Reason Codes reference file with the latest WPC published code
set. Codes Added: 10 ; Codes Deleted/Terminated: 0 ; Codes Modified: 5. The new
codes are: "213 - Non-compliance with the physician self referral
prohibition legislation or payer policy.", "214 - Workers'
Compensation claim adjudicated as non-compensable. This Payer not liable for
claim or service/treatment. (Note: To be used for Workers' Compensation
only)", "215 - Based on subrogation of a third party
settlement", "216 - Based on the findings of a review
organization", "217 - Based on payer reasonable and customary fees.
No maximum allowable defined by legislated fee arrangement. (Note: To be used
for Workers' Compensation only)", "218 - Based on entitlement to
benefits (Note: To be used for Workers' Compensation only)", "219 -
Based on extent of injury (Note: To be used for Workers' Compensation
only)", "220 - The applicable fee schedule does not contain the
billed code. Please resubmit a bill with the appropriate fee schedule code(s)
that best describe the service(s) provided and supporting documentation if
required. ...", "221 - Workers' Compensation claim is under
investigation. (Note: To be used for Workers' Compensation only. Claim pending
final resolution)" and "D22 - Reimbursement was adjusted for the
reasons to be provided in separate correspondence. ...". The modified
codes are: 85, 100, 151, 189 and 201.
Remittance Remarks Code (RARC) Reference File Update Source: WPC
ͺ Updated the
Remittance Remarks Codes reference file with the latest WPC published code set.
Codes Added: 1 ; Codes Deleted: 0 ; Codes Modified: 4. The new code is :
"433 - Resubmit this claim using only your National Provider Identifier
(NPI)". The modified codes are: MA97, MA116, N174 and N421.
GENERAL PRODUCT ENHANCEMENTS
Institutional Claim Print Module
ͺ Modified the
Institutional Claim Print Module to support printing of the line-level National
Drug Code (NDC) information on UB-04 printed claims. The NDC code and optional
NDC Units/Type values are printed in the Revenue Code Description (FL43) field
as described in the Official UB-04 Data Specifications Manual from NUBC (see
the Clarifications/Errata/Updates dated 11/15/2007).
Auto Populating
Value Code 61 with CBSA on Non-Medicare Claims
ͺ Modified the Institutional claim form to extend the "Core Based Statistical Area" (CBSA) auto-population feature to non-Medicare lines of business. This feature automatically populates Value Code "61" during claim entry with the CBSA value on file for the selected patient. Previously, this feature was available for Medicare claims only (TOBs 32x, 33x, 34x, 81x and 82x). This enhancement extends this feature to any LOB/TOB combination as defined by a product configuration setting. Contact your software distributor for assistance if you would benefit from this enhanced capability.
Remittance Remark Codes (RARC) Enhancement of Effective and Termination
Dates
ͺ Added
effective/terminate dates to the Remittance Remark Codes (RARC) reference file.
Added several non-fatal Institutional claim edits to insure the RARC codes
reported on Coordination of Benefits (COB) claims were valid when adjudication
took place. This change was prompted by a change in the ANSI code sets
published by Washington Publishing Company (WPC). They are now maintaining
start/stop dates for this code set.
Taxonomy Code
Enhancement of Effective and Termination Dates
ͺ Added
effective/terminate dates to the Taxonomy Codes reference file. Added several
non-fatal Institutional claim edits to insure the Taxonomy codes reported on
the claims were valid for the applicable service date range. This change was
prompted by a change in the ANSI code sets published by Washington Publishing
Company (WPC). They are now maintaining start/stop dates for this code set.
CORRECTIONS TO CUSTOMER REPORTED PROBLEMS
Institutional Claim Form
ͺ Modified several Institutional claim edits added
recently per CMS mandate CR5746 (Transmittal 1348) to accommodate Home Health
claims whose Service From/Thru Date range spans from 2007 into 2008. Specific
edit changes include: (a) Modified an existing Institutional claim edit which
restricts billing of the new HHRG codes to Revenue Code 0023 on TOB 32x/33x claims
such that it now checks against the claim's Service Thru Date. ; and (b)
Modified an existing Institutional claim edit which requires an HHRG code on
Home Health PPS claims such that it no longer considers the claim's service
date since this check is already being performed by another edit.
Institutional Claim Import Module
ͺ Modified the Institutional
Claim Import Module to properly handle the special Present On Admission (POA)
string reported in the K3/2300 segment when more than seventeen (17) Other
Diagnosis Codes are reported in the ANSI-837 file. The import module will now
consider these excess diagnosis codes when analyzing the POA string length, and
when extracting the POA indicators for assignment to their respective diagnosis
codes. Previously, the import module would report an invalid POA string length
when excess Other Diagnosis Codes were reported. Note that PC-ACE Pro32 still
supports a maximum of seventeen (17) Other Diagnosis Codes per claim.
Installing the Upgrade
Perform a full PC-ACE Pro32 database backup before installing the upgrade. To install the upgrade, run the attached PCACEUP.EXE file using Windows Explorer or equivalent, and follow the simple upgrade wizard steps. When prompted, enter the upgrade password provided by your software supplier. For networked instructions, it is recommended (but not required) that the update be run from the servers console.
IMPORTANT: The recommended database
backup is for safety purposes only, and should NOT be restored after
successfully installing the update. The
update program preserves all existing claims and reference file settings.