Wednesday, February 28, 2007

Illinois Locality 16 Fees downloadable file issue

During the dates of February 12 - February 20th of 2007 if you downloaded Medicare of Illinois Localty 16 fees please reivew this alert -

WPS Medicare inadvertently posted the incorrect fees for Illinois Locality 16 affecting the downloadable file version only on 02/12/07. We posted the correct fees to the Website on 02/20/07.

If you sent in claims for Illinois Locality 16 for 2007 dates of service, AND you only billed the allowed amount based upon the fee schedule allowed amounts, AND you used the fees from the version of the downloadable file for Illinois Locality 16 posted between 02/12/07 - 02/20/07, you may be affected.

Please note this DOES NOT AFFECT YOU IF:
• You did not download IL locality 16 fees from our Website between February 12-20, 2007
• You used the "Download All States" feature
• You used the viewable PDF for Illinois Locality 16
• You used the downloadable Illinois Locality 16 feature previous to or after February 12-20, 2007

If you submit your claims with actual billed amounts, and do not adjust your billed amount to reflect the Medicare allowed amount, this error will not affect you. In other words, if you do not bill based on the Medicare Physician Fee Schedule Relative Value File allowed amount, but rather on your own individually determined pricing, this error will not have affected your reimbursement. You will have received the correct allowed amount when your claim processed. This error only affects providers who bill the Medicare allowed amounts based upon the allowed amounts for Illinois Locality 16 posted to the WPS Medicare Website February 12, 2007 - February 20, 2007.

Please call 877-867-3418 and request a telephone reopening in order to receive your correct reimbursement amount. Please mention that you are requesting a telephone reopening based on the "Website fee error" and that you need to change the amount you billed. This is carrier error and we will reprocess it to reflect the correct reimbursement level. If you prefer to request a reopening in writing, please submit our new reopening request form found at on our Website.

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