PACE

 Provider Bulletin

March 27, 2009

 

Disallowed Claims

 

 

As stated in the March 6, 2009 Provider Bulletin, PACE is currently developing an edit to ensure that the Other Coverage Code (OCC) 6 “Other Coverage Denied-Not a Participating Provider” is being used correctly.

 

Providers were told that until that edit implementation, paid history would be examined and claims disallowed if found to be submitted with an OCC 6 by a Part D enrolled provider.

 

Claims voided as a result of this first review appear on the Remittance Advice dated March 27.

 

If necessary, corrected claims may be resubmitted to the Program on-line within ninety (90) days of the date of service.

 

Providers should contact the member plan if they are unsure of the Part D claim submission time.

 

 

BILLING CARDHOLDERS FOR DISALLOWED OCC 6 CLAIMS IS A VIOLATION OF THE PACE PROVIDER AGREEMENT. 

 

 

 

 

 

 

 

Questions may be directed to Provider Services at 1-800-835-4080.