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340B Hospital Billing Reminder

Health Partners Plans (HPP) would like to remind you that all billing requirements must be adhered to in order to ensure that required data is captured. To be accepted as a valid claim, the submission must contain correct current coding, including but not limited to CPT, HCPCS, DRG, Revenue and ICD-10 codes and modifiers.

Hospitals must follow CMS requirements for billing 340B modifiers under the hospital outpatient prospective payment system. All claims for drugs and biologicals purchased through the federal 340B Discount Drug Program must be billed on a separate claim line with the appropriate 340B modifier (i.e. “JG” or “TB”). Hospitals that participate in the 340B Program must maintain documentation in accordance with CMS requirements and comply with applicable reporting requirements. Depending on the provider’s contract with HPP, the reporting of 340B modifiers may impact fee schedule allowances or be collected for informational purposes only.

In the event HPP identifies claim submissions that do not contain complete and correct coding, HPP may either reject the claim, request additional information prior to payment, or retrospectively audit applicable payments.

If you have any questions, please contact the Provider Services Helpline at 1-888-991-9023 (Monday–Friday, 9 a.m.–5:30 p.m.) or your NAM (Network Account Manager).

Resources
Feb. 19: Full communication to providers