Erroneously Denied Claims for Presumptive Eligibility for Pregnant Women

Effective retroactively for dates of service on or after July 1, 2015, a claims processing issue has been identified involving the Application for Presumptive Eligibility Only (MC 263) form of the Presumptive Eligibility (PE) for Pregnant Women program. Due to a printing error, PE Proof of Eligibility cards listed truncated identification numbers, which should be 14 digits. Claims submitted with the truncated identification numbers are being erroneously denied. Providers should resubmit affected claims in hardcopy form with an attached copy of the PE Proof of Eligibility card. Providers should also enter “See attached” in the Remarks field (Box 80) for UB-04 claims or in the Additional Claim Information field (Box 19) for CMS-1500 claims.