1. Decision – Edits with NCD/LCD Documentation Only
CareSource will remove these edits as it evaluates supporting policies and communications as to reasons for implementing edits. Transparency and proactive communications are important to CareSource before implementing.
Due to the fact that these edits were implemented with NCD/LCD documentation only, we will reprocess any Institutional & individual Providers/Physicians claims, dates of service back to 10/1/2015, for claims denied since the edit go live date. This will include the following edits:
Glycated Hemoglobin/Glycated Protein – Go Live Date – 11/3/2016
Non-invasive Vascular Studies – Go Live Date – 11/10/2016
Polysomnography & Sleep Studies – Go Live Date – 11/10/2016
Transthoracic Echocardiography - Go Live Date – 11/10/2016
Hepatitis Panel/ Acute Hepatitis Panel - Go Live Date – 11/10/2016
Thyroid Testing - Go Live Date – 11/10/2016
Vitamin D - Go Live Date – 11/10/2016
Note: Just because a claim is reprocessed does not mean that it will result in payment. Additional ICD-10 standard coding edits have been updated in our system which have led to an increased denial rate. (Ex. ICD-10 code billed may only be used as first-listed or primary diagnosis position.) We will allow these claims to be corrected and resubmitted until 7/1/2017 and waive timely filing.
CSMG Proprietary & Confidential

2. Decision – Edits with Policies
CareSource will not be making changes to the following edits because documentation is available to support the edit that has been implemented in production.
Chemotherapy & Biologicals – 2 Policies
Controlled Substance Monitoring & Drug Abuse Testing – The only edit implemented was for 2016.
Intravenous Immune Globlin (IVIG)
Sexual Transmitted Infection (STI)
3-Day Window – OAC Rule
Polymerase Chain Reaction Genetic Testing (PCR)
CareSource has a fiduciary responsibility to recover overpayments.
CareSource will process recoveries for claims paid in error back to 1/1/16.
CSMG Proprietary & Confidential