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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.

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 2/2/2023 

 
Open Issues Impacted Provider Types Impacted Program(s)

Details

Issue Resolution status Claim Project Status Target Completion  Date*
CPT® Code 90651Gardasil Denying Incorrectly All Providers HealthChoice, MMAI, YouthCare CPT® Code 90651Gardasil Denying Incorrectly (Notice Date 1/13/23) (PDF) Solution Identified In Progress 2/28/2023
Laboratory Codes Denying ExIM All Providers HealthChoice, MMAI, YouthCare Laboratory Codes Denying ExIM (Notice Date 1/13/23) (PDF) Solution Identified Creation 2/28/2023
Hearing Aids Denying EX46 Audiologist HealthChoice, MMAI, YouthCare Hearing Aids Denying EX46 (Notice Date 1/13/23) (PDF) Research Creation 2/28/2023
Vaccine Codes Paying at Incorrect Rate  All Providers HealthChoice, MMAI, YouthCare Vaccine Codes Paying at Incorrect Rate (Notice Date 1/25/23) (PDF) Research Creation 2/28/2023
EAPG COVID Overpayments  All Providers HealthChoice, MMAI, YouthCare  EAPG COVID Overpayments (Notice Date 1/9/2023) (PDF) Solution Identified In Progress 2/28/2023
Anesthesia Codes Denying ExXe Anesthesia Providers HealthChoice, MMAI, YouthCare Anesthesia Codes Denying ExXe (Notice Date 1/9/2023) (PDF) Solution Identified Creation 2/28/2023
DME- Orthotics denying EX35  All Providers HealthChoice, MMAI, YouthCare DME- Orthotics denying EX35 (Notice Date 10/28/2022) (PDF) Solution Identified Creation 2/28/2023
HCPCS G0008 and G0009 paying @25% of billed charges  All Providers HealthChoice, MMAI, YouthCare HCPCS G0008 and G0009 paying @25% of billed charges (Notice Date 8/29/22) (PDF) Solution Identified Creation 2/28/2023
Patient Credit file being applied twice Hospice Long Term Care HealthChoice, MMAI, YouthCare Patient Credit file being applied twice (Notice Date 10/14/2022) (PDF) Solution Deployed In Progress 3/31/2023
Hospice Claims billed with Rev Code 658 denying EXya All Providers HealthChoice, MMAI, YouthCare Hospice Claims billed with Rev Code 658 denying EXya (Notice Date 11/9/2022) (PDF) Solution Identified Creation 3/15/2023
IP claims paying incorrect DRG All Providers HealthChoice, MMAI, YouthCare IP claims paying incorrect DRG (Notice Date 11/18/2022) (PDF) Research Creation 3/15/2023

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

Billing Opportunities

Issue Provider Type Guidance

 

 

 

 

 

 

CPT® is a registered trademark of the American Medical Association