Claims billed with modifier 92 that denied or paid incorrectly to be mass reprocessed or adjusted

The Indiana Health Coverage Programs (IHCP) has identified a claim-processing issue that affects certain claims with dates of service (DOS) on or after July 1, 2016. Fee-for-service claims billed with modifier 92 – Alternative laboratory platform testing may have denied inappropriately or paid incorrectly due to denied claim detail line with one of the following explanation of benefits (EOB): claims processed before February 13, 2017, in IndianaAIM, may have denied for EOB 4224 – First modifier not valid for dates of service and claims processed on or after February 13, 2017, in CoreMMIS, may have denied with EOB 251 – First modifier invalid. The claim-processing system has been corrected. Claims that previously denied or that paid incorrectly due to a denied claim detail line for EOB 4224 or EOB 251 will be mass reprocessed or mass adjusted. Providers should begin to see the reprocessed or adjusted claims on Remittance Advices (RAs) beginning the week of May 29, 2017, with internal control numbers (ICNs)/Claim IDs that begin with 80 – Reprocessed denied claims or 52 – Mass replacement non-check related.

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INDUSTRY NEWS TAGS: Medicaid Indiana

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