Meridian to Implement Additional Claim Edits

Date: 01/20/22

Effective February 25, 2022, edits will be added to all claims with Dates of Service January 1, 2021 for Meridian Medicare-Medicaid (MMP); July 1, 2021 for Meridian Medicaid Plan and April 1, 2020 for YouthCare HealthChoice Illinois.

As a reminder if you receive a denial you may send a corrected claim. Corrected claim(s) may be submitted via EDI, Meridian’s secure web portal or via paper. For corrected claims please remember to include the 12-character original claim number of the paid/denied claim in Field 64 of the UB04 when submitting a replacement or void on the corresponding A, B, C line reflecting the Health Plan from field 50. This applies to claims submitted with a Type of Bill (field 4). Frequency of “7” (Replacement of Prior Claim) or Type of Bill, Frequency of “8” (Void/Cancel of Prior Claim).

Additional Reference material can be found in the IAMHP Billing Guide.

Long-Term Care claims with an Inpatient or Outpatient claim on the same Date of Service (DOS)
Long-Term Care claims should be billed for the DOS the member is in the facility. If the member is admitted for an acute IP stay, LTC should not be billed for the dates the member is IP. For claims billed with a TOB 21X, 22X, 65X, or 66X with a discharge status of 20 or 30 – the claim will deny with code EXnb – R&B DAYS DO NOT EQUAL COVERAGE PERIOD if Meridian has received an IP stay from an acute care facility with overlapping days.

Long-Term Care Claims Billed with Leave of Absence Days
All Long-Term Care claims billed with revenue code 018X – Leave of absence must also include occurrence code 074 indicating a leave of absence. Claims billed with revenue code 018X that do not include an occurrence code 074 will deny EXnj – VALUE/OCCURRENCE SPAN CODES MISSING OR INVALID. Example: Admit Date 1/1 to 1/31. Revenue code 018X billed for 3 days. Occurrence code 80 reported with 31 units and Occurrence code 74 not reported.

Additionally, the LOA days billed for revenue code 018X must equal the unit value of Occurrence code 74. If the days and units are not equal the claim will deny EXnk – NUBC OCCURRENCE CODE INVALID. Example: Admit date 1/1 to 1/31: 6 LOA days. Occurrence code 80 should be reported with a unit value of 25 and Occurrence code 74 should be reported with a unit value of 6.

Outpatient Billed while Patient is Inpatient
Claims will be denied for outpatient services when the member’s outpatient date of service falls into a date range when he/she has a claim listing him/her as an inpatient. An edit will be added to the outpatient facility services that are billed during the same date span as the member’s inpatient claims. The claim will be denied when Outpatient and Inpatient Bill Type are billed on the same date of service.

Outpatient Bill Type	Inpatient Bill Type
13x, 14x, 23x, 34x, 71x, 72x, 73x, 74x, 75x, 76x, 83x, 85x, 32x, 33x, 89x	11x, 12x, 18x, 21x, 22x, 41x, 65x, 81x, 82x

 

Invalid Billing for Hemodialysis Services
Meridian requires that claims billed with revenue code 0634 – EPO less than 10,000 units or 0635 – EPO over 10,000 units must also be billed with revenue code 080X-088X. Hemodialysis must be present for every distinct date of service. Claims billed with 0634 and 0635 that do not include a corresponding 080X-088X for each service date(s) the full claim(s) will be denied with code EXno – INVALID DATES OF SERVICE PLEASE RESUBMIT.

Example: If a dialysis provider billed with Rev 0634 or 0635 on 11/11 and 11/13, then the claim must also include
Revenue Code 080X-088X for 11/11 and 11/13.

Reported Value Codes Inconsistent with Statement Period
For inpatient claims with Bill Types and Revenue codes listed below the total days reported with Value code 80, 81, & 82 amounts must equal the Statement To and From Dates in Field 6 of the UB04 claim form, with variance reported in Field 17.

The amounts reported for the covered and non-covered days value codes at the claim header must balance with the Statement to and From Dates, accounting for the fact that the last day of the statement span may or may not be counted based on the discharge status and claim frequency code values. Claims that the statement date differs from the sum of the Value Code Days will deny with code EXno- INVALID DATES OF SERVICE PLEASE RE-SUBMIT.

Bill Type	Revenue Codes	Value Codes
11x, 12x, 21x, 22x, 65x, 82x, 86x, 89x	100-219, 1000-1005, 942	80, 81, & 82

Example:

·       Admit through Discharge with discharge status other than 30 – Value code sum of 80, 81, 82 must equal DOS Thru Date minus DOS From Date

·       Interim claim with discharge status of 30; Value Code Sum of 80, 81 and 82 must equal DOS Thru Date – DOS From Date +1