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Printed Date: 9/22/2015
Ambulance mileage services under the prior authorization model, HCPCS code A0425, have been originally paid in error because the transport for the same date of service was denied for prior authorization coverage. Providers should refund the payment upon receipt of the overpayment letter that will be sent as mass adjustments are periodically performed.
The criteria for these adjustments are as follows:
Some providers have seen a denied transport when viewing the remittance advice (RA) in eServices but did not see a line item for the mileage even though it was billed on the same claim. The reason the mileage is not seen is that the claim is being split. The denial of the transport due to prior authorization is being split into a separate claim and the RA is being sent out immediately while the mileage claim (since it is being paid) is on a separate claim awaiting the 14 day payment floor. Then the mileage payment is made on a separate RA.
Since the mileage is paying in error due to a system limitation, mass adjustments are made periodically to request that payment back as it is an overpayment. This was previously listed as an issue on the Claims Payment Issues Log (CPIL) and the Prior Authorization webpage. It is resolved as there is a process in place to address any impacted claims.
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Last Updated: 04/18/2017