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Medical Supplies Billing Requirements: FAQs - TARs and SARs
How will active Treatment Authorization Requests (TARs) and Service Authorization Requests (SARs) that have been issued with local codes for dates of service on or after April 1, 2009 be handled?
A: A 90-day grace period will be extended for previously approved TARs and SARs that include an authorization period after April 1, 2009 for the local "99" code.This means that providers must continue to bill the local “99” codes on claims with approved TAR and SARs through the end of the grace period on June 30, 2009. Using the new coding requirements from the revised provider manual pages, providers can start submitting new TARs and SARs to cover service periods beyond June 30, 2009 on previously approved TARs and SARs. The system will automatically end-date TARs that extend beyond the June 30, 2009.
Medi-Cal is currently working with the Medi-Cal field offices and the Califronia Children’s Services (CCS) program to ensure a comprehensive transition plan is in place to assist providers with submitting TARs/SARs with the new billing requirements. Information and updates concerning the TAR/SAR submission requirements and the 90-day grace period are included in Medi-Cal Updates. In addition, the Medi-Cal Web site contains information specific to the new medical supply billing requirements.
Will Medi-Cal field offices be notified of the need for new TARs and SARs?
A: Yes. Medi-Cal is currently working with TAR field offices and the CCS program to ensure a comprehensive transition plan is in place to assist providers with submitting new TARs and SARs. Providers will be kept informed of progress on this transition plan through bulletins, workgroups and training sessions.
Will Medi-Cal field offices notify providers of existing TARs with local medical supply codes?
A: Medi-Cal field offices will not have the ability to contact all providers or maintain a list of providers that have TARs with local medical supply codes. However, field office staff will be on alert to assist providers during this transition period.
Will the TAR or SAR control numbering system make it possible to identify TARs or SARs issued prior to the code conversion?
A: No, TARs and SARs approved prior to the code conversion will not be identifiable by the TAR/SAR control number.
- Because the Medical Supplies Billing Requirment changes impact so many codes and existing TARs/SARs, will the Medi-Cal field offices and the CCS program offices have adequate staff to handle this added work load?
A: Medi-Cal and CCS field offices are prepared to assist providers during the transition period. Providers are able to submit new TARs/SARs with effective dates on or after April 1, 2009 with the appropriate Healthcare Common Procedure Coding System (HCPCS) Level II codes. This extended time period should help reduce number of TARs and SARs with local codes during the transition period to HCPCS Level II codes. More information about the new TAR/SAR submission requirements will continue to be provided in the monthly Medi-Cal Updates.
- Can the Medi-Cal computer systems automatically “crosswalk” the local “99” codes on TARs/SARs for services on or after April 1, 2009 to HCPCS Level II codes?
A: No. Due to the "one-to-many" relationship between local codes and HCPCS Level II codes, the Medi-Cal claims processing system cannot automatically convert local codes to HCPCS Level II codes on TARs/SARs. This is an assumption that cannot be made from the perspective of a claim-processing system. Providers must determine which HCPCS Level II codes are appropriate for TARs/SARs.
When the provider determines what HCPCS Level II code will replace the local code on an existing TAR/SAR, will the field office accept the HCPCS Level II code listed on the new TAR/SAR without further documentation?
A: Yes. If the authorization period does not suprass the approved authorization period on the original TAR or SAR, the field office will accept the HCPCS Level II codes. However, if the service authorization period is longer than the approved authorization period, medical justification documentation must accompany the TAR or SAR.
A TAR is now required for some medical supplies that have not needed one in the past. Has this requirement changed for other types medical supply products?
A: Yes. Effective April 1, 2009, the TAR requirements will change for some medical supply items. Specific items that previously did not require a TAR will require authorization while other items that currently require a TAR will not need one (vice-versa). Medi-Cal made this determination because some HCPCS Level II codes for certain products are not specific and other codes did not coincide with existing local “99” codes.
- Where will the CCS program send the lists of existing SARs with local “99” codes approved for dates of service on or after June 30, 2009?
A: The lists of existing SARs with approved services on or after a June 30, 2009 date of service will be sent to the local CCS program offices. Providers are encouraged to contact their local CCS program office for more information about handling SARs during the transition period.
- Will a SAR that was authorized for CCS after January 5, 2009 with local “99” codes continue to be valid through June 30, 2009 date of service?
A: Yes. If the SAR with local “99” codes was authorized through June 30, 2009, it will still be valid. If providers submit a claim using the new HCPCS Level II codes, they can request those codes for dates of service on or after April 1, 2009. If providers need a longer transition time, they can request the previous “99” codes for dates of service through June 30, 2009.
- Can a provider add new codes to an existing SAR rather than creating a new one?
A: No. There cannot be different effective dates for different items on a SAR.
- Will the medical supply changes that were effective for CCS providers on September 1, 2008 where a separate SAR is not needed for medical supplies that fall within Medi-Cal threshold limits continue on or after April 1, 2009?
- Will the SARs for Service Code Grouping (SCG) 01 and 02 continue to cover medical supplies?
A: Yes. SARs for both SCGs will continue to apply to medical supplies with the new HCPCS Level II codes.
- Some medical supplies can be billed with a SAR for SCG 01, SCG 02, a doctor or a Special Care Center (SCC). Will this procedure continue?
A: Yes. Effective for dates of service on or after April 1, 2009, providers may submit a claim using the new HCPCS Level II codes with a SAR for SCG 01, SCG 02, a doctor or an SCC when the Medi-Cal threshold limits are not exceeded.
- Will the new HCPCS Level II codes be included for the medical supplies in SCG 01 for CCS?
A: Medical supply codes are not included in the SCG. If there is a CCS claim for medical supplies, the claims processing system searches for the SCG/SAR. The SCG/SAR number must be on the claim. If medical supplies billed are within the appropriate Medi-Cal limits, the claim will be paid.
- How should CCS providers in Los Angles County that do not use SARs update codes for previously approved medical supplies and note it appropriately on their claims?
A: Authorizations in Los Angeles County are not specific to any procedure code. Therefore, providers should continue to bill as usual and indicate the names of the medical supplies being dispensed so that the county can compare what was billed to what was authorized and verify its accuracy. If a provider receives an authorization from the county that is procedure code specific, the provider should have the county modify the authorization to reflect the new HCPCS Level II code(s).
Is there a designated CCS representative for providers to contact about SARs?
A: No. Medical supplies are not included in the SCG. If there is a CCS claim for medical supplies, the claims processing system searches for the SCG/SAR. If medical supplies billed are within the appropriate Medi-Cal limits, the claim will be paid. The SCG/ SAR number must be on the claim.
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