Apple Health (Medicaid) Provider Alert
What changed?
Retroactive for claims with dates of service on and after September 1, 2022, the Health Care Authority (HCA) pays claims billed with the PN modifier at EAPG rates per HCA’s Outpatient Prospective Payment Systems (OPPS) fee schedule. HCA has removed the following information from the Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy, under the Outpatient hospital facility heading:
As of 1/1/21 claims billed with the PN modifier are paid at 46% EAPG rates. Providers are subject to post pay review. If it found that modifier PN should have been used at the time of billing, recoupment of payment may occur.
See Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy, under COVID-19, Policies and billing guidance for the updated policy.
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