Medically Unlikely Edits Should Not Deny Claim Lines that Are Prior Authorized, CR 59426

An issue was discovered where some claim lines were being denied for “medically unlikely” when the claim had a prior authorization. This denial was an error. The system has been updated and affected claims will be reprocessed.  No provider action is needed.

Source: https://content.govdelivery.com/accounts/MEHHS/bulletins/1b48f6d