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| Claims Processing Change for Modifiers KH, KI, and KJ This article is to alert suppliers to a change in the manner in which National Government Services processes claims for capped rental items or PEN pumps submitted with an incorrect KH, KI, or KJ modifier. Suppliers are reminded to submit claims with the appropriate KH, KI, or KJ modifier when submitting claims for capped rental items or PEN pumps. When billing a capped rental item or a PEN Pump, modifier KH shall only be used for the first month of billing. Modifier KI shall only be used for the second and third months of billing. Modifier KJ shall then be used for the remainder of the capped rental period (months 4-13), and the PEN pump rental period (months 4-15). In addition to the KH, KI, and KJ modifiers, suppliers must remember to include any additional modifiers required to ensure proper processing. Currently, when a claim for capped rental items or PEN pumps is received with an incorrect KH, KI, or KJ modifier, National Government Services manually corrects the claim in order to allow for proper processing. However, effective with claims processed on or after January 1, 2010, National Government Services will no longer correct these claims. Effective with claims processed on or after January 1, 2010, claims with an incorrect KH, KI, or KJ modifier will be rejected with ANSI Reason Code 4 and 16 and Remark Code 56. Additionally when a capped rental item was previously provided to the beneficiary and a new rental period is being requested (due to a break in need/break in service, reasonable useful lifetime of equipment has been reached, loss, theft, or irreparable damage) a narrative must be added that clearly explains the reason the item is being replaced, and a new capped rental period started, in order to avoid unnecessary rejections. The narrative explanation must be included in box 19 of the CMS 1500 claim form or the NTE segment of the electronic claim. National Government Services will begin rejecting claims that include modifier KH when a previous initial capped rental month is on file and the claim is submitted without a narrative that clearly supports a new rental period. These claims will also reject with ANSI Reason Code 4 and 16 and Remark Code 56. Claims rejected due to an incorrect K modifier, must be resubmitted with the correct KH, KI, or KJ modifier. Suppliers will no longer be able to use the reopening process to correct this type of claim submission error. |
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