We’ve seen an increase in claim denials as a result of the incorrect use of applicable modifiers with certain service codes. As a result, we want to remind you that all billed services must have an applicable modifier. Please note that many services can have more than one applicable modifier, and all must be included in order for the claim to be paid.
Please note that all modifiers and requirements are listed out in the coding manual which can be found on the Department of Health Care Policy and Financing (HCPF) website.
If you submit your claims through a clearinghouse, please contact your clearinghouse to inquire which fields in their software to enter the modifier(s) that will interface to “Box 24D” of the CMS1500 form that we will receive.
Substance Use Disorder Services: Any substance use disorder service should be indicated with the HF modifier, which can ONLY be in the second modifier position. There must be another applicable modifier placed in the first position.
Effective Immediately: Claims with HF billed in the first position will be denied. Claims with HF in the second position and blank in the first position will also be denied.
Effective January 1, 2018: All other services must have an applicable modifier in the first position. If this is blank, claims will be denied effective January 1, 2018. Please see individual code pages for applicable modifiers related to the billed code.
Please send an email to your assigned provider network services representative with questions about this requirement. Please contact ProviderNetworkServices@coaccess.com if you do not know your currently assigned provider network services representative.