Affiliation Claim Edit for Sep. 2016

Effective Feb. 6, 2017, the claim edit disposition will change from “pay and report” to “pend” and will no longer give the informational message. Once the disposition is changed, a claim failing the edit will suspend for 60 days. Providers will continue to receive EOB 07025: THE RENDERING PROVIDER IS NOT AFFILIATED WITH YOUR PROVIDER GROUP. CONTACT THE RENDERING PROVIDER AND ASK THEM TO COMPLETE A MANAGED CHANGE REQUEST ADDING YOUR PROVIDER GROUP NPI ON THE AFFILIATED PROVIDER PAGE WITHIN THE NEXT FOUR WEEKS TO PREVENT CLAIMS BEING DENIED. If the affiliation relationship is not established within that time period, the claim will be denied. Providers must correct any affiliation issues immediately.

Source: https://ncdma.s3.amazonaws.com/s3fs-public/documents/files/Medicaid_Bulletin_2016_09.pdf