June 19, 2019 - Important Notice Regarding End Stage Renal Disease (ESRD) Payment Cases

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Important Notice Regarding End Stage Renal Disease (ESRD) Payment Cases
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In an effort to expedite the processing of ESRD payment cases, effective immediately, all Plans will be required to call into the Quality Net Help Desk to open an ESRD trouble ticket.

The MAPD Help Desk and the Division of Payment Operations (DPO) will no longer be taking calls or tickets relating to ESRD missing payments.  Please note that this is ONLY for cases where an ESRD period is incorrect or missing thereby causing incorrect payments.  All other ESRD issues, including transplant cases, should still be reported to DPO through the MAPD Help Desk. 

ESRD tickets already sent to the MAPD Help Desk have been evaluated by DPO and processed via the Center for Clinical Standards and Quality’s (CCSQ) CrownWeb system. ESRD periods that were corrected will calculate proper payment adjustments and will be applied in an upcoming payment cycle.  ESRD periods that were rejected will need the assistance of the CCSQ to perform additional follow up. 

Going forward, Plans are encouraged to contact the Quality Net Help Desk with new cases and follow up questions on previously closed ESRD tickets which may require additional help.   Please direct all questions or concerns to the Quality Net Help Desk at 1-866-288-8912 or email at qnetsupport@sdps.org.