Claims With Rate Reductions May Have Shown Incorrect EOB Messages

Medicaid Texas has identified an issue that affects claims that were processed between February 25, 2011, and March 1, 2011. Procedure codes that received a rate reduction may have contained incorrect explanation of benefits (EOB) messages that indicated that a one-percent reduction and a two-percent reduction were applied to the reimbursement for the same procedure code. Only the EOB messages are incorrect. The correct reduction was applied to the applicable line items. Affected claims will be reprocessed, and the correct EOB messages will be applied to the claim. The reprocessed claim with the corrected EOB messages will appear on a future R&S Report. The claims payment will not be affected by the reprocessing.

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