Fee Schedule and Program Changes

Fee Schedule and/or Program Changes: When Meridian receives a fee schedule update or program change from HFS, we will load the change to the claim system as quickly as possible. See below for loading schedule. At times Meridian will receive a fee schedule or program change after the effective date. Providers do not need to request reprocessing of claims as Meridian will automatically reprocess all impacted claims once the change is loaded into the claims system. Interest will apply to claims reprocessed more than 45 days after the notification of the change. Claims with billed charges less than the published charge will not be reprocessed. Providers should always bill with usual and customary charges to avoid this situation.

 

Production Status
In-Progress System is currently being updated to reflect change
Completed System is updated to pay claims per the HFS fee schedule or program change
No Updates Needed System is already configured to pay per HFS fee schedule or program change

 

 Claim Adjustment Status

 

  
Pending Claims reprocessing has not begun  
In Progress Claims to reprocess based on HFS fee schedule or program change have been identified and a project submitted  
Completed Claims reprocessing is complete  
N/A System was updated prior to receiving claims. No reprocessing needed  



Fee Schedule Updates and Program Changes

Title Date Received from HFS Effective Date Production status Completion Date of Production Claims Adjustment Status and/or Completion Date
7/1/23 Practitioner Fee Schedule 9/13/2023 7/1/2023 In Progress   Pending
Reminder to MCO's for Psych add on payment for certain hospitals 9/1/2023 Varies Completed 9/14/2023 In Progress
$113 add-on for Outpatient Psychiatric claims (eff 01.01.23) 8/24/2023 1/1/2023 In Progress   Pending
Correct Outpatient rates for Javon Bea Hospital 8/24/2023 Varies In Progress   Pending
Revised Outpatient EAPG Calculators - Javon Bea Hospital & Rockford/OSF St Elizabeth-Ottawa 8/24/2023 Varies In Progress   Pending
Final 1/1/2023 Calculators and Rate Sheets for UHS Hospitals (IP/OP Hosp Calculators EAPG & APR-DRG 1.1.23-7.31.23) 8/23/2023 1/1/2023 In Progress   Pending
Policy/billing change effective 01/01/2024 CPT 99483  8/21/2023 1/1/2024 Completed 9/5/2023 N/A
ICF/IID and MC/DD Rate Changes Effective January 1, 2023 8/17/2023 1/1/2023 In Progress   Pending
Maternity Care Reimbursement Changes Effective 10.1.2023
 8/15/2023 10/1/2023 In Progress   Pending
Pharmacists Billing for HIV Pre- and Post-Exposure Prophylaxis Assessment and Consultation per Public Act 102-1051 8/9/2023 1/1/2023 In Progress   Pending
HCBS rate increases effective 1/1/24 8/9/2023 1/1/2024 Completed 8/21/2023 N/A
Revised IP and OP Calculators effective 8/1/23 - updated 8/1/2023 8/1/2023 Completed 8/16/2023 Pending
B4105 - RELiZORB Pricing Increase 7/28/2023 6/1/2023 Completed 7/31/2023 In Progress
Renal Dialysis Rates and Provider Updates 7/28/2023 Varies Completed 8/10/2023 In Progress
Rate Increase for Breast Tomosynthesis Procedures Effective January 1, 2023, per Public Act 102-1018 7/18/2023 1/1/2023 Completed 7/18/2023 In Progress
Revised IP and OP Calculators Effective 8/1/2023 - with updates 7/18/2023 8/1/2023 Completed 8/16/2023 Pending
NF & SLP Rates - 7/1/23 7/6/2023 7/1/2023 Completed 7/6/2023 N/A
Practitioner Fee Schedule and updated Key effective 4/1/23 6/20/2023 4/1/2023 Completed 7/19/2023 In Progress
Podiatric Fee Schedule effective 4/1/23 6/20/2023 4/1/2023 Completed 7/18/2023 N/A
Practitioner Fee Schedule Effective 01/01/2023 Updated 03/15/2023 6/6/2023 1/1/2023 No Updates   Pending
Long Acting Injectables - effective 07/01/2023 6/2/2023 7/1/2023 In Progress   Pending
DME Fee Schedule O&P Codes
 5/26/2023 6/1/2023 Completed 6/7/2023 N/A
Care Program In-Home Service Rate Increase - Effective 4/1/2023 5/1/2023 4/1/2023 Completed 3/16/2023 N/A
Rate Correction Letter for West Suburban 4/27/2023 Varies Completed 5/8/2023 Completed
Updated LPHA (Licensed Practition) 4/19/2023 4/1/2023 Completed 3/28/2023 N/A
Updated Practioner Fee Schedule - Revised Effective 1/1/2023 4/13/2023 1/1/2023 Completed 5/4/2023 Completed
NF and SLP Rates 4/1/2023 4/6/2023 4/1/2023 Completed 4/7/2023 N/A
Updated COVID-19 fee schedule 4/6/2023 Varies Completed 4/7/2023 N/A
Coding Change for Depression Screenings Effective April 1, 2023  3/28/2023 4/1/2023 Completed 3/29/2023 N/A
Practitioner Fee Schedule eff 1/1/2023 3/15/2023 1/1/2023 Completed 3/29/2023 Completed
SBHC Fee Schedule eff 1/1/2023 3/15/2023 1/1/2023 Completed 4/4/2023 N/A
Podiatry Fee Schedule eff 1/1/2023 3/15/2023 1/1/2023 Completed 3/31/2023 N/A
Updated COVID-19 fee schedule 3/13/2023 1/1/2023 Completed 3/14/2023 N/A
Revised RY 23 MPA MHVA Rates (additional update on 3.10.23) 3/6/2023 10/1/2022 Completed 3/28/2023 Completed
Revised rate sheet for Montrose Behavioral Hospital for Children 2/14/2023 1/1/2023 Completed 3/28/2023 Completed
St. James final MPA rate after late appeal   2/14/2023 10/1/2022 Completed 2/24/2023 Completed
Coverage of Interprofessional Consultation Procedure Codes for Psychiatric Services Effective February 1, 2023  2/3/2023 2/1/2023 Completed 2/22/2023 N/A
Updated Practitioner Fee Schedule for 12/31/2022 1/12/2023 12/31/2022 No Updates   N/A
Medicaid Rate List for Nursing Facilities, County Nursing Facilities, and SMHRF's 1/10/2023 1/1/2023 Completed 1/12/2023 N/A
Supportive Living Program Rates Effective January 1, 2023 1/10/2023 1/1/2023 Completed 1/17/2023 N/A
Covid-19 Fee Schedule Update 1/9/2023 Varies Completed 1/12/2023 Completed
Final RY 2023 MPA and MHVA Rates to Plans - 10.03.22 - 09.30.2023 1/6/2023 10/1/2022 Completed 2/2/2023 Completed