|
SUBC REQUEST FORM (submit one form per item/please print or type)
Submitted by: __Joe Biller, Memorial Hospital__________________ Date: __01-01-97_______
Date Reviewed by SUBC: ___________ Action Taken: Approved Denied Pending
Effective Date for Change: ___________ Date Communication sent to Provider: ____________
Comments: __________________________________________________________________
|
|
Questions to ask when preparing this request. Include answers in your request. ( ) What are other states' policies and reporting requirements? ( ) Is this request uniform with other payers? ( ) How are other payers reporting this information? ( ) Is this unique to your facility? ( ) How will this affect providers? How many providers are/will be affected? ( ) Are there other methods available to meet this request? ( ) Can this request be accommodated with HCPCS, ICD-9, or CPT-4 codes? |
|
THIS IS A REQUEST FOR A: (x) INFORMATIONAL ITEM/NEWSLETTER INFORMATION - Reminder artucke about renewals (draft attached) (x ) UNIFORMITY ISSUE: _The XYZ Company has implemented a new program which requires providers to reconfigure their systems to report the date of service for laboratory services in F.L. 84 Remarks. This is a uniformity issue which affects several providers doing business with XYZ company. This requirement is not uniform with the UB-92 because F.L. 45 allows them to collect the date of service on the same line as the laboratory service. Other payers utilize F.L. 45. Attached is XYZ company's requirement policy._ |
|
(x) PAYER UPDATES: ABC of Michigan will begin using a National Provider Identifier (NPI) on 12-01-97. The NPI will replace the Unique Physician Identification Number which is reported in F.L. 82. All providers will be impacted since this is a national effort. All other states and payers will have to accomodate claims that have the NPI reported on it. Attached is the implementation schedule and anticipated changes to the manual. |
|
(x) PROVIDER CONCERN: XYZ of Michigan's voucher is not reporting all of the digits for the patient account number. This impacts the providers that submit claims to XYZ of Michigan. ABC of Michigan reports 15 characters on their vouchers. In order for the voucher to be useful to the provider, it would be helpful if XYZ of Michigan would expand the field on the voucher for the patient account number to 15 characters. |
|
(x) CORRECTION TO MANUAL; Page I-45 (please attach the revised page) Typographical error |
|
(x) ADDITION TO MANUAL Description of Addition: New condition code for ambulance transportation between hospitals. Code Z1 is suggested. Five other state hospital associations, and three out of state plans were contacted regarding the need to report this information. Three other states and two plans have created a code to indicate ambulance transportation. The others do not have a need to report this information. Other payers within the state do not cover this service. All providers that have hospital owned ambulance services would be effected. This condition code would allow the provider to submit a request for payment of the service that may not otherwise be payable. |
|
(x) REQUEST FOR NATIONAL UNIFORM BILLING COMMITTEE (NUBC) In order for a request to be taken to NUBC you must prepare a complete analysis explaining the reason for your request. In the analysis you must explain why the SUBC can not accommodate it, how the change will help other states, and answers to the above questions. The formal request and analysis will be reviewed by SUBC for approval prior to submission to NUBC. Reminder: NUBC meets twice a year, May and November. Requests that are approved at NUBC become effective October 1 and April 1, respectively. |
| Please mail/fax form to: |
|
State Uniform Billing Commitee, Michigan Health and Hospital Association 6215 W. St. Joseph Hwy Lansing, MI 48917 Fax: 517-327-4564 |
|
NOTE: ALL REQUESTS MUST BE SUBMITTED WITH SUPPORTING DOCUMENTATION TO MHA AT LEAST TWO WEEKS PRIOR TO THE SUBC MEETING DATE IN ORDER TO BE INCLUDED IN THE MEETING PACKET |