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SHPBN-2016-045 Important Information about TPL HCBS Cost Avoidance Removal

Date: 06/20/16

In accordance with state policy, effective with dates of service on and after July 1, 2016, third party liability (TPL) edits will be bypassed for the attached HCPCS Level II procedure codes.

What does this mean for you?

Beginning with claims billed for date of service July 1, 2016, the attached procedure codes will not be edited for TPL. Sunflower Health Plan will reimburse for these procedure codes as the primary payer regardless of TPL.

This policy will complement the current non-covered Code List maintained by KDHE. KDHE will continue to post blanket denials received from carriers if applicable. All Medicare cost avoidance editing will remain in place as the system currently bypasses editing according to existing Medicare coverage indicators.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Specialist or call our Customer Service Center at 1-877-644-4623.