SHPBN-2016-006 Annual and Quarterly Code Changes
Date: 02/12/16
Annual and Quarterly HCPCS Code Changes
In cooperation with KDHE and with regards to benefit and pricing determinations, Sunflower Health Plan will make annual and quarterly HCPCS code changes, including additions, revisions and deletions, effective with dates of service on and after the effective date for each HCPCS code update.
Code Changes Processing Timeline:
- SYSTEM UPDATES – Updates and changes to Sunflower Health Plan Claims Processing system may take up to 30 business days.
- DENIED CLAIMS – While Sunflower’s Claim Processing system is being updated, providers submitting new or changed codes may experience claim denials that contain the message EXcL: DENY:NO ACTION NEEDED – WILL BE REPROCESSED AFTER STATE REVIEWS NEW CODE.
- PAID CLAIMS – Claims paid for deleted or terminated codes will be reprocessed as part of the reprocessing effort below. Providers will need to submit a corrected claim with an active replacement code.
- REPROCESSING OF DENIED or PAID CLAIMS – Sunflower Health Plan will proactively identify and initiate claims projects to reprocess any claims that were denied or paid while system updates were being made. Please note that claim projects may take up to 30 days for reprocessing, depending on the number of claims and providers affected.
If you have questions about this bulletin or other provider resources, please contact our Customer Service Center at toll free 1-877-644-4623.