REVISED AND CLARIFIED PLACE OF SERVICE CODING INSTRUCTIONS

In May we alerted our providers that MetroPlus will be implementing a change to its existing policies and procedures in the next several months. This change is outlined below, and we are reminding you that it will become effective September 1, 2019. If you have any questions regarding these updates, you may contact your Network Relations Representative, or call MetroPlus Provider Network Services at 1-800-303-9626.

In accordance with Centers for Medicare & Medicaid Services (“CMS”) Change Request (“CR”) 7631 (Transmittal 2679), entitled “Revised and Clarified Place of Service Coding Instructions”, certain changes to reimbursement are required based upon the designated Place of Service (“POS”). This setting designation may impact providers’ level of reimbursement. This change will only impact providers’ reimbursement for health care services rendered in a facility setting (e.g hospital, ambulatory services, etc.) Providers’ reimbursement for health care services rendered in an office setting will not be impacted.

As described in the Compensation attachment of its provider agreement, MetroPlus has been reimbursing its providers for Covered Services rendered to Members at a MetroPlus fee schedule, which is based on an approximation of a percentage of the Medicare RBRVS rate. Effective September 1, 2019, MetroPlus will adjust its reimbursement according to CMS’ CR #7631, based on POS code provided on claims.

Thank you and we look forward to your continued participation with MetroPlus Health Plan.