Subject: Fee-for-service claim reprocessing planned for February 17, 2017

The weekend of February 17, 2017, the Oregon Health Authority (OHA) will reprocess institutional and professional claims that were incorrectly denied from September 21, 2016, through September 29, 2016. On September 21, OHA closed payment for a small number of ICD-10 diagnosis codes that were supposed to close on 9/30/2016. As a result, OHA denied any claims that contained the closed ICD-10 codes and processed from September 21 through September 29, 2016, regardless of the claim’s service dates. To correct this, MDOR is now reprocessing all claims that were submitted on these dates, using these diagnosis codes. No action is required on your part. The Claims Paid section will list the affected claims with a Detail EOB code of 8008: Provider Requested Claim Adjustment Due to Misc. or Unspecified Error. Both the ERA and Provider Web Portal will list Adjustment Reason Code 16: Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Again, no action is required on your part.