Providers may resubmit claims denied for EOB codes 1003 and 1004

  • July 28, 2017

The Indiana Health Coverage Programs (IHCP) identified an issue in CoreMMIS affecting claims from certain providers enrolled with the IHCP under more than one provider classification. The issue caused some claims from these providers to deny inappropriately for the following explanations of benefits (EOBs): 1003 – Billing provider not enrolled at the service location submitted on the claim for...

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Provider Enrollment – Upcoming Process Improvement for Applications

  • July 28, 2017

Conduent is taking steps to reduce the processing time of Provider Enrollment applications, and will be implementing a new process that gives the provider the opportunity to correct and resubmit returned applications sooner. Effective July 31st, Conduent will no longer pend incomplete Provider Enrollment applications. If an application contains missing or incorrect documentation, the application...

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Carolina Healthcare System Agrees To Pay $6.5 Million To Settle False Claims Act Allegations-Urine Drug Tests

  • July 28, 2017

U.S. Attorney Jill Westmoreland Rose announced today that the Charlotte-Mecklenburg Hospital Authority, dba Carolinas Healthcare System (CHS), has agreed pay the Government $6.5 million to resolve allegations that the company violated the False Claims Act, by "up-coding" claims for urine drug tests in order to receive higher payment than allowed for the tests.

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Comparative Billing Reports Drugs of Abuse Testing Webinar- August 23, 2017

  • July 28, 2017

CMS will be sponsoring a webinar on the comparative billing reports of Drugs of Abuse Testing (CBR201706). During the webinar, providers will receive the opportunity to interact directly with content specialists and submit questions about the report. CBR201706 is an educational tool designed to assist providers who referred or ordered procedures for drugs of abuse testing with...

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Reprocessing of Erroneously Paid and Denied Clinical Laboratory Claims- Drug Testing codes

  • July 28, 2017

The Department of Health Care Services (DHCS) has identified a claims processing issue affecting claims billed with the following clinical laboratory CPT codes 80300-80369. This issue caused some claims to erroneously pay and some claims to erroneously deny with Remittance Advice Details (RAD) code 0188: This is a “By Report” procedure. No report is attached or the attached report is insufficient...

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Issue Corrected: Denied Claims due to National Correct Coding Initiative (NCCI) Editing

  • July 28, 2017

The issue where some claims have denied in error due to NCCI editing on previously denied claims has been corrected. 

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Bundling by Tax ID and Specialty Claim Edits Standardization

  • July 28, 2017

On August 1, 2017, Blue Cross and Blue Shield of Alabama will implement the first of its industry standardization claim edits. Currently, bundling edits are applied to claims for an individual provider. For claims processed on or after August 1, 2017, bundling edits will be applied to all providers under the same Tax ID with the same Specialty, regardless of date of service. As a reminder, Blue...

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Clinicians: Medicare Part B Crossover Claims Issue Tied to Error Code H31312

  • July 28, 2017

Since July 6, there has been a problem with 837 professional coordination of benefits/Medicare crossover claims in which Medicare is the secondary payer. The issue is specific to the Primary Payer 2320 AMT for claims that were submitted electronically with detail Primary Payer 2430 SVD amounts included. The system is not passing the primary payer’s paid amount correctly; therefore, affected...

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