IHCP to reprocess claims that denied incorrectly with EOB 3001

With the implementation of CoreMMIS, the Indiana Health Coverage Programs (IHCP) has identified a number of prior authorization (PA) issues – some that have affected claim processing. Providers may have submitted claims on or after February 13, 2017, for reimbursement consideration before the related PA was approved. This would have caused the claim to deny with explanation of benefits (EOB) 3001 – Dates of service not on the PA master file. The IHCP recognizes that delays and other issues related to processing PAs may have led to these inappropriate claim denials. As a result, the IHCP will mass reprocess all claims previously processed on or after February 13, 2017, that denied for EOB 3001. Providers should begin to see the reprocessed claims on Remittance Advices (RAs) beginning April 11, 2017, with Claim IDs/ICNs that begin with 80 (Reprocessed Denied Claims).

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INDUSTRY NEWS TAGS: Medicaid Indiana

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