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HIPAA Provider Information

Effective Immediately

In preparation for compliance with the Health Insurance Portability and Accountability Act (HIPAA), UNICARE no longer accepts local codes from providers if there is an equivalent HCPCS (Health Care Financing Administration Common Procedure Coding System) code or CPT (Current Procedural Terminology) code. Local codes are non-standard codes that are often used to support specific processing purposes.

Listed below are some of the local codes that have been mapped to valid CPT/HCPCS codes for Community Health Centers:


OLD CODE NEW CODE
X5582 99050
X5583 99054
X5901 T1015-TH
X5902 T1015
X5903 90899
X5904 T1015-HQ


Local use modifiers (i.e. EP/Y3) and anesthesia modifier 30 are no longer valid modifiers. Anesthesia services should be submitted with valid ASA codes.


Effective 4/30/03 HIPAA standard denial reason codes are used on UNICARE's Provider Remittance Advices (RA's). Below is a listing of the HSP denial codes, the old description and the new HIPAA compliant description.

CODE OLD DESCRIPTION HIPAA DESCRIPTION
DNDIA Denied, Invalid Diagnosis Code Please Resubmit Payment denied because the diagnosis was invalid for the date(s) of service reported.
DNITB Denied, Itemized Bill Required Claim/service lacks information which is needed for adjudication.
DNMHL Submit Charges to MassHealth Limited Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
DNPRC Denied, Invalid Revenue/Procedure Code, Please Resubmit Payment denied because this procedure code/modifier was invalid on the date of service or claim submission.
DNPRM Denied, Procedure Code Missing Payment denied because this procedure code/modifier was invalid on the date of service or claim submission.
DNTIM Services submitted exceed the filing limit The time limit for filing has expired.
DNUCP Submit Charges to the Uncompensated Care Pool Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
EXPLN Plan Exclusion Non-covered charge(s).
LM300 Plan Limit of $300 Per Year Benefit maximum has been reached.
LM5NV Plan Limit of 5 Visits per Year Benefit maximum has been reached.
LMH10 Plan Limit of 10 Visits per Year Benefit maximum has been reached.
LMHNV Plan Limit of 2 Visits per Year Benefit maximum has been reached.
NTMHL Submit to MassHealth Limited or Uncompensated Care Pool Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
DNMBH Claim needs to be billed through Magellan Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
DNPOS Denied, Incorrect or Missing Place of Service The procedure code/bill type is inconsistent with the place of service.
DNEOB EOB From Other Carrier Required for Payment Consideration Claim/service lacks information which is needed for adjudication.
DNFYC Denied, Fiscal Year Closed and No Funding is Available Non-covered charge(s).



For additional information please refer to the following website: www.cms.hhs.gov/hipaa

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