`Ohana has added a Claims and Payment Policy (CPP) to ensure accurate payment adjudication for claims where the use of modifiers, 24, 25, 59, and X (E,S,P,U) is present. This CPP is publicly available on our website.
Visit https://www.wellcare.com/Hawaii/Providers/Medicaid/Claims/Payment-Policy to view
this updated policy. Please share this notice with other members of your practice and office staff.
Beginning June 1, 2020, our clinical teams will use this Modifier CPP to review claims with modifiers 24, 25, 59, and X(E,S,P,U) for supporting documentation and/or proper usage. Therefore, providers may experience an increase in requests for medical record submissions when billing modifiers, including 24, 25, 59, XE, XP, XS or XU.
The intent of this change is to ensure appropriate use of modifiers upon claim submissions. Once the requested medical records are received and reviewed, `Ohana will approve final payment if claims have appropriately used the referenced modifiers.
Thank you for your continued partnership in providing quality care to your patients, our members.
