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Provider Claim Alerts

Please review the below information on known claim processing issues and action items to resolve.

System Configuration Issues: These issues occur when the claims system is not configured to pay claims per guidelines. In most cases no action is needed by provider as Meridian will automatically reprocess impacted claims once the system configuration is corrected. If providers will be required to resubmit claims, information will be posted below in the Details section.

Retro State Fee Schedule and/or Program Changes: Theses claims projects occur when Meridian receives a fee schedule update or program change from HFS after the effective date of the change. Providers do not need to request reprocessing of claims as Meridian will automatically reprocess all impacted claims once the change is loaded into the claims system. Interest will apply to claims reprocessed more than 45 days after the notification of the change. Claims with billed charges less than the published charge will not be reprocessed. Providers should always bill with usual and customary charges to avoid this situation.

Billing Opportunities: When Meridian identifies an opportunity for clarification of billing requirements, information will be posted to allow providers an opportunity to submit a corrected claim for adjusted reimbursement as appropriate

If you have a claim that should be included in one of the claim projects below (which you believe denied incorrectly) and it has not yet been adjusted as of the date the project is closed, please let us know the claim number so that we can research it and confirm. You may  confirm claim status via the Meridian Service Portal (preferred), contacting the call center at 866-606-3700 or reach out to your provider contact for more information.

 

Issue Resolution Status Key

  • Research: Issue is being investigated, no action needed at this time. Please monitor this page for further information.
  • Solution Identified: Root cause of the issue has been identified, but system update is not yet completed.
  • Resolution Deployed: System has been fixed, current claims processing correctly, claims reprocessing will occur for prior claims.

Project Status Key

  • Creation: Meridian is in the process of identifying the impacted claims.
  • In Progress: The project is actively being worked and payments will begin to be issued.
  • Batch Complete: Most claims in the project have been systematically reprocessed with the exception claims which have fallen to manual reprocessing.
  • Completed: Claims included in the claim project have reprocessed. Note, this is not a guarantee of payment, during the reprocessing of claims may hit additional claim edits.

For questions about global issues or the associated claims projects, please contact Provider Services or reach out to your provider contact for more information.

System Configuration

Updated 4/25/2022 12:47 p.m.

Open Issues Impacted Provider Types Details Issue Resolution status Claim Project Status Target Completion Date*
CPT® codes for COVID administration denying EXGT FQHC, RHC and Encounter clinics Details (PDF) Solution Deployed In Progress 5/15/22
G0299 denying EXVI Hospice Details (PDF) Solution Deployed In Progress 5/15/22
C and P HCPCS denying EX46 Facilities Details (PDF) Solution Deployed In Progress 5/15/22
BH claims in correctly denying EX18 BH, CMHC Details (PDF) Solution Identified In Process Ongoing until system is corrected
S5130 overpaid from 1/27/22 through 2/10/22 Waivers Details (PDF) Resolution Deployed Creation TBD
CPT® codes for COVID administration denying EXNT FQHC, RHC and Encounter clinics Details (PDF) Solution Identified In Progress 5/30/22
CPT® 96110 denying EXIM and EXys Practitioners Details (PDF) Solution Deployed Creation TBD
CPT® 99000 COVID Specimen denying EXys All Providers Details (PDF) Solution Identified Creation TBD

 *Project completion is when the batch process has finished. Not inclusive of manual changes.

Retro State Fee Schedule Updates and Program Changes

State Change Data Received from HFS Date System Update Completed Project Target Completed Date
n/a n/a n/a n/a

Billing Opportunities

Issue Provider Type Guidance
n/a n/a n/a

 

Completed Projects

Below is a listing of completed claim projects. If you have a claim that should be included in one of the completed claim projects below (which you believe denied incorrectly) and it has not yet been adjusted, please let us know the claim number so that we can research it and confirm. Please reach out to your provider contact for more information.

Issue IMPACTED PROVIDER TYPES Details ISSUE RESOLUTION STATUS CLAIM PROJECT STATUS
A0130 incorrectly denying for Health Choice and YouthCare Ambulance Details (PDF) Solution Deployed Batch Completed
A0130 and A0425 incorrectly denying for MMAI Ambulance Details (PDF) Solution Deployed Batch Completed
CPT® 36416 denying EXIM - Missing or Invalid Modifier Physicians Details (PDF) Solution Deployed Batch Completed
Claims Denying for EX2b, 2C, 2c, 2E, 2f and 2G for Health Choice, Youth Care and MMAI All Providers  Details (PDF)  Solution Deployed Batch Completed

 

 

CPT® is a registered trademark of the American Medical Association