I’m not sure if you’ve had a problem with Medicaid requiring MSRP’s in your area, but in NH we have had issues. Medicaid claims are processed by Xerox here. Xerox put in a new computer system, MMIS, and all of the sudden our custom items like foot Orthotics and even some custom TLSO’s and AFO’s were hitting an edit and requiring MSRP’s. I decided to really fight this because there really should not be MSRP’s required on items that we fabricate in-house. In contacting the head people in charge of policy at Xerox, I found out that they had no idea that things had changed AND they agreed that claims edits should not be looking for MSRP’s on these items. I had to send them spreadsheets on my suspended claims so they could check everything out. There were lots of e-mails and calls back and forth. But, all was worth it!
I just found out today that the policy has been changed! They will no longer require MSRP’s on custom items and they will be processing at 85% cost, as was being done prior to the new computer system. Yeah!! Good to have a victory in our favor for a change!!!
Maggie Perez
Office Manager
Capital O & P
246 Pleasant St
Concord, NH 03301
603-226-0106
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Capital Orthotics and Prosthetics, LLC
246 Pleasant Street, Suite 200, Concord, NH 03301
603-226-0106 / fax 603-226-0845
www.CapitalOandP.com
