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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 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 In-Progress   Pending
Updated Pracitioner Fee Schedule eff 7/1/2022 8/24/2022 7/1/2022 Completed 9/14/2022 Pending
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 Pending
Hospital Outpatient Claims for Sexual Assault Treatment Services per Public Act 102-0699 7/28/2022 7/1/2022 Completed 8/18/2022 Pending
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 Pending
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 Pending
OP High Volume Adjustment - Revised Rates eff 7/1/2022 6/30/2022 7/1/2022 Completed 8/22/2022 Pending
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