Adjustment Coming Soon

DMAP will be processing a Mass-Adjustment of claims due to changes related to patient liability on third-party claims. Providers will see the adjusted claims on their September 25, 2017 Remittance Advice (RA). Claims to be included in this process will be for claims submitted between 1/1/2017 through 9/1/2017. These claims paid at zero dollars when there was another payer on the claim and the patient liability was $0.00. Claims included EOB – 9923 PRICING ADJUSTMENT – PATIENT LIABILITY DEDUCTION APPLIED. These adjusted claims will start with a region ‘52’. A reminder that DMAP will suspend for review, and require an EOB attached to claim submissions, when the Third-Party Liability (TPL) payment amount is less than 60% of the DMAP allowed amount.