12 I Fall 2018 www.anjc.info Insurance Update Medicare Q&A Legislative U New Disclosure Form: On June 1, 2018, Governor Murphy signed into law the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act. The main components of the bill were designed to protect patients from unexpected out-of-network bills for providers operating at in-network hospitals or other healthcare facilities. There are, however, several new disclosure requirements that apply to all providers, including chiropractic physicians. The new law requires the Board of Chiropractic Examiners to develop a Uniform Disclosure Form for all chiropractors to have patients sign consistent with the new law. However, the uniform disclosure form was not finalized by the Board by the effective date of the new law, August 29, 2018. Nor has the uniform disclosure form been created by the time of this printing. In the interim, the ANJC has developed a sample form that addresses the disclosures required by the new law. Please be advised that this form is a sample only and each member must tailor it to their individual practice situation. Further, once the Board promulgates its uniform disclosure form, the uniform disclosure form will supersede any interim forms and must be used by all chiropractors from the official date of promulgation forward. It is important to note that, despite this bill being focused on (per the title) out-of-network providers; all providers should have patients sign the form. This is due to the fact that a patient may change their plan, leading to them be out-of-network with a formerly in-network provider; or a provider may remove themselves from a network, hence leading to a former in-network patient being out-of-network. You can find the ANJC’s interim sample form on the home page www.anjc.info under Latest News or in the Insurance section under News and Updates. The ANJC will advise as to the progress of implementation of the Uniform Disclosure Form as this information is received. Medicare CMS 1500 Forms: We have heard from numerous members who have received rejections from Medicare due to a format issue concerning dates on the CMS 1500 claim submission form. Our regional Medicare Admin- istrative Contractor (MAC), Novitas, began rejecting claims that did not have the proper date formatting as of July 30, 2018. The proper data formatting requirements are: You must report an 8-digit birth date (MMDDCCYY) in the following places within the CMS 1500 form: 3 Patient’s Birth Date 9b Other Insured’s Date of Birth 11a Insured’s Date of Birth When reporting 8-digit birth dates, there must be a space between the month, day, and year (i.e., MM_DD_CCYY). On the CMS-1500 claim form, the space between month, day, and year is delineated by a dotted, vertical line. You have the option of entering a 6-digit or 8-digit date in the following items: 11b  Employer’s Name or School Name 12  Patient or Authorized Representative 14 Date of Current Illness 16  Dates Patient Unable to Work in Current Occupation 18  Hospitalization Dates Related to Current Services 19  Additional Claim Information (Designated by NUCC) 24a Date of Service 31  Provider of Service or Supplier, or their Authorized Representative Whether you use a 6-digit date or 8-digit date for items 11b, 14,16,18,19 and 24a, the format must be used consistently in each of these areas. Note: When reporting a date in Item 24a, it must be one continuous number (i.e., MMDDCCYY), without spaces between month, day, and year. To reference this directly from Novitas, you can find it at the website www. novitas-solutions.com; choose the JL district > Claims > More . . . > Coding and Billing > Date Formatting Requirements CMS 1500 form or enter this URL in your web browswer: http:// www.novitas-solutions.com/webcenter/ portal/MedicareJL/pagebyid?con- tentId=00176922 Horizon 98943: As previously reported, Horizon had been errone- ously denying 98943 due to a faulty claim edit update. The denials took place from January through April 2018. The claim edit issue was corrected first. Horizon then began the process of correcting the payments. We have now been advised by Horizon that all identified, inappropriately denied 98943 claims have been reprocessed with reimbursements being issued. If you believe that you received erroneous 98943 denials earlier this year that have not yet been corrected, or if you receive any new denials on 98943 with a reason code you do not understand or think is inappropriate, please email matt@anjc.info. By Matt Minnella ANJC Director of Insurance & Regulatory Affairs 2018 FALL INSURANCE UPDATE