Update: medical claims adjustments
A medical claims adjustment was required to reprocess claims for ‘E079A smoking cessation: initial discussion with patient’. The updated payment rules for this were implemented November 1, 2023, with an effective date of December 1, 2022.
Also included was the reprocessing of claims for ‘K900A – Biosimilar Support Fee’. The updated payment rules for this were implemented November 1, 2023, with an effective date of March 31, 2023.
Additionally, further reprocessing was required to accumulate the following services towards eligible physicians’ palliative care special premiums. The updated payment rules for this were implemented November 1, 2023, retroactive to December 1, 2022. This adjustment did not require the adjustment of the following claims as they were correctly paid:
- A945A – Special palliative care consultation
- C945A – Special palliative care consultation
- K023A – Palliative care support
Claims for smoking cessation: initial discussion with patient (E079A) processed between December 1, 2022, and October 31, 2023, and biosimilar support fee (K900A) processed between March 31, 2023, and October 31, 2023, were subject to the adjustment. These claims have been adjusted in accordance with the Schedule of Benefits.
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