IHCP will mass adjust or reprocess outpatient claims billed with ICD-10 diagnosis codes N18.9 or N19 that denied incorrectly

The Indiana Health Coverage Programs has identified fee-for-service claims billed with ICD-10 diagnosis codes N18.9 – End stage renal disease or N19 – Acute kidney failure unspecified with dates of service (DOS) on or after October 1, 2015, that may have been erroneously denied with explanation of benefits (EOB) 2006 – Emergency services only – members are eligible for a payment only for emergency services. Outpatient claims billed with ICD-10 diagnosis codes N18.9 or N19 for the DOS indicated that previously denied with EOB 2006 will be mass adjusted or mass reprocessed. Providers should begin to see the adjusted or reprocessed claims on the Remittance Advice (RA) statements dated October 4, 2016, with internal control numbers (ICNs) that begin with 56 (mass adjusted) or 80 (mass reprocessed). For claims that were underpaid, the net difference will be paid and reflected on the RA.