Update: Missing Dates of Service on Outpatient Crossover Claims

Indiana Medicaid published an article August 28, 2012, regarding outpatient crossover claim denials for explanation of benefit (EOB) 264 – Date of service missing. These claims are received by the IHCP directly from Medicare, where the date of service (DOS) at the detail level is no longer required. When the claim crosses over electronically to the IHCP, the DOS is missing at the detail level, causing the claim to deny for EOB 264. The article indicated that system changes had been made to prevent these outpatient crossover claim denials effective August 22, 2012, and that claims would systematically reprocess. It was subsequently discovered, however, that additional system changes were needed for the claims to process and price correctly. This error has caused a delay in reprocessing claims that were denied for edit 264. The systematic reprocessing will now begin appearing on Remittance Advice (RA) statements dated September 18, 2012. These claims can be identified with internal control numbers (ICNs) that begin with region code 80.