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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
Updated Practitioner Fee Schedule for 12/31/2022 1/12/2023 12/31/2022 In-Progress   Pending
Medicaid Rate List for Nursing Facilities, County Nursing Facilities, and SMHRF's 1/10/2023 1/1/2023 In-Progress   Pending
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 In-Progress   Pending
Final RY 2023 MPA and MHVA Rates to Plans - 10.03.22 - 09.30.2023 1/6/2023 10/1/2022 In-Progress   Pending
Community Care Program - In Home Rate Increase - 1/01/2023 **    12/22/2022 1/1/2023 Completed 12/16/2022 N/A
10/1 rates for SNF and SLF - for Decatur Manor - Sharon Health Care Woods 12/22/2022 10/1/2022 Completed 12/28/2022 Pending
Update to Outpatient Rates for OSF St. Elizabeth – Ottawa 12/16/2022 10/1/2019 In-Progress   Pending
Correct Outpatient rates for Javon Bea Hospital 12/16/2022 7/1/2019 In-Progress   Pending
Updated C-19 fee schedule - Note on end date of Bebtelovimab 12/14/2022 Varies Completed 12/29/2022 N/A
Rate increases for DRS and Aging effective 1/1/2023 (homemaker) 12/8/2022 1/1/2023 Completed 12/16/2022 N/A
10/1 Practitioner Fee Schedule 12/2/2022 10/1/2022 Completed 1/17/2023 In-Progress
SMHRF Rate Updates 12/1/2022 Varies Completed 12/5/2022 In-Progress
FQHC and RHC rates for CY 2023 State revision 12/5/2022 11/29/2022 1/1/2023 Completed 12/22/2022 N/A
2023 Increases - Dental and Transportation 11/18/2022 1/1/2023 Completed 12/15/2022 N/A
Retroactive Rate Change for Methodist Medical Center, Peoria (eff 01.01.22) 11/10/2022 1/1/2022 Completed 11/25/2022 In-Progress
IDOA Enhanced rate-Homemaker Providers Increase 11/10/2022 11/1/2022 Completed 11/17/2022 N/A
New Novavax Booster eff 10/19/22 for age 18+ (COVID 19 Fee Schedule) 11/3/2022 10/19/2022 Completed 11/14/2022 N/A
Updates due to capital rate exceptions - grouped by rate quarter  (Retro LTCF Rates) 11/1/2022 Varies Completed 11/17/2022 In-Progress
Advanced copy of updated COVID-19 fee schedule 91314, 0144A, 91315, 0154A Effective 10/12/2022 10/28/2022 10/12/2022 Completed 11/4/2022 Completed
Updated COVID-19 fee schedule 10/24/2022 Varies Completed 12/7/2022 Completed
Quantity Limit for HCPCS A4393 10/7/2022 9/1/2022 Completed 11/8/2022 N/A
Updated (CBS) Community-based Behavioral Health Services Fee Schedule - Effective 07/01/2022  10/6/2022 7/1/2022 Completed 7/13/2022 N/A
New COVID-19 Booster Vaccinations 9/30/2022 Varies Completed 9/15/2022 N/A
Hospice Annual Rate Changes Effective October 1, 2022 9/22/2022 10/1/2022 Completed 9/27/2022 N/A
RY 23 Initial MPA MHVA Rates 9/19/2022 Varies Completed 11/18/2022 In-Progress
Revised OP hospital rate sheet for Ingalls Memorial 9/19/2022 7/1/2022 Completed 12/16/2022 In-Progress
Updated COVID-19 fee schedule 9/14/2022 Varies Completed 9/15/2022 N/A
Monkeypox (MPV) - Advanced Notice of Testing Code/Rate 9/2/2022 7/26/2022 Completed 9/15/2022 N/A
Renal Dialysis Rate and Provider Updates 9/2/2022 Varies Completed 10/25/2022 In-Progress
Updated Pracitioner Fee Schedule eff 7/1/2022 8/24/2022 7/1/2022 Completed 9/14/2022 In-Progress
Updated Practitioner Fee Schedule Modifier  Effective 08/11/2022 8/11/2022 7/1/2022 Completed 4/27/2022 Pending
SUPR Rate Sheet for MCO's Version - July Version 8/3/2022 1/1/2022 Completed 8/8/2022 N/A
Hospital Outpatient Claims for Sexual Assault Treatment Services per Public Act 102-0699 7/28/2022 7/1/2022 Completed 10/3/2022 N/A
Podiatry Fee Schedule 7/25/2022 4/1/2022 Completed 8/5/2022 N/A
Updated COVID 19 Fee Schedule(Novavax vaccine/admin code addition) 7/21/2022 7/13/2022 Completed 7/25/2022 N/A
Optometry Fee Schedule Update 9/1/2022 7/18/2022 9/1/2022 Completed 7/19/2022 N/A
New Rates for LTC 7/13/2022 7/1/2022 Completed 7/20/2022 N/A
Hospital Outpatient Claims with JW Modifier 7/12/2022 11/18/2021 Completed 8/8/2022 In-Progress
Supportive Living SLP Rate Update 7/12/2022 7/1/2022 Completed 7/14/2022 N/A
Changes in Billing Policy for Integrated Assessment and Treatment Planning (IATP), Community Support, and Crisis Stabilization Services 7/1/2022 7/5/2022 Completed 7/8/2022 N/A
SMHRF July 1 Rate Increase (specialized mental health rehabilitation facilities) 6/30/2022 7/1/2022 Completed 8/9/2022 N/A
Updated 2021 Practitioner Fee Schedule - eff 4/1/22 6/30/2022 4/1/2022 Completed 8/3/2022 In-Progress
OP High Volume Adjustment - Revised Rates eff 7/1/2022 6/30/2022 7/1/2022 Completed 8/22/2022 In-Progress
Birth Center Rates eff 7/1/2022 6/29/2022 7/1/2022 Completed 7/13/2022 N/A
Immunization Administration Rate Increase to $16.71 Effective 7/1/2022 6/23/2022 7/1/2022 Completed 6/30/2022 N/A
HB4700 CMHC Rate Increases on Specified Services eff 7/1/2022 6/15/2022 7/1/2022 Completed 6/23/2022 N/A
New Modifier 93 and Place of Service 10 have been added to telehealth benefits eff 7/1/2022 3/31/2022 7/1/2022 Completed 6/6/2022 N/A
Modifier 93 and Place of Service Code 10 Implementation 4/1/2022 3/21/2022 7/1/2022 Completed 4/25/2022 N/A