Provider Claim Alerts

Update: As of 9/21/23, Meridian identified and resolved the source of EDI claim rejections that occurred between 9/16 and 9/20. Meridian’s clearinghouse inadvertently directed claims to an incorrect claims platform rather than the correct Meridian claims system. As of 9/21/23, all of the misdirected claims were resent by the clearinghouse to the correct claims system. Providers do not need to resubmit any of the claims that were rejected between 9/16 and 9/20. Note: as a result of the resubmission, some claims may reject a second time appropriately. If you have any questions, please reach out to customer service at 866-606-3700 or contact provider relations.

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.

Rescinded Recovery Projects: At times, Meridian may find cause to cancel a recovery project.  When this occurs. Meridian has determined that the notification of overpayment is rescinded.  If you received an overpayment notification and you find the project number referenced in that notification on this list, you do not need to take any further action.  The project has been canceled an claims will not be recouped. To find the project number of the rescinded Recovery projects, please review your notice in the upper right hand corner and you will see the project number listed. Please retain a copy of the recovery letter for reference if needed in the future.

 

 

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 9/14/2023 

Known Issue Resolution Status
Open Issues Impacted Provider Types Impacted Program(s)

Details

 Issue Resolution status Claim Project Status Target Completion  Date*
DME Orthotics Codes denying EX46 Orthotic and Prosthetic HealthChoice, MMAI, Youthcare DME Orthotics Codes denying EX46 (Notice Date 9/14/23) (PDF) Resolution Deployed  In Progress 10/31/2023
Optical Visits not reimbursing fee for service FQHC and RHC FQHC and RHC HealthChoice, MMAI, Youthcare Optical Visits not reimbursing fee for service FQHC and RHC (Notice Date 9/14/23) (PDF) Solution Identified  Creation 10/31/2023
Claims Denying EX35 for 97110 All Providers HealthChoice, MMAI, YouthCare Claims Denying EX35 for 97110 (Notice Date 8/4/23) (PDF) Resolution Deployed Creation 10/30/2023
Immunizations billed with CPT® 90707 and 90716 Were Incorrectly Denied as EXxa All Providers HealthChoice, MMAI, YouthCare Immunizations billed with CPT® 90707 and 90716 Were Incorrectly Denied as EXxa (Notice Date 4/6/23) (PDF) Resolution Deployed In Progress 10/31/2023
Discarded Drugs billed with modifier JW paying in error All Providers HealthChoice, MMAI, YouthCare Discarded Drugs billed with modifier JW paying in error (Notice Date 5/5/23) (PDF) Solution Identified Creation 9/30/2023
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 Deployed In Progress 8/31/2023
Waiver Code Overpayment Waiver Providers HealthChoice, MMAI, YouthCare Waiver fee schedule has been changed (Notice Date 6/30/2023) (PDF) Solution Deployed In Progress 9/30/2023
Patient Credit File (PCF) Recoupment Overpayment All Providers HealthChoice, MMAI, YouthCare

 Overpayment due to retroactive eligibility update (Notice Date 6/30/2023) (PDF) Solution Deployed

 In Progress 9/30/2023
Incorrect Coding Denials for limited E HCPCS DME All Providers HealthChoice, MMAI, YouthCare Claims for certain DME service billed with E codes are incorrectly denying the supply codes with EXys (Notice Date 7/5/2023) (PDF) Solution Deployed In Progress 10/31/2023
Claims Denying for G8510 and G8431 for Depression Screening All Providers HealthChoice, MMAI, YouthCare

 HFS added HCPCS codes G8510 and G8431 (Notice Date 7/5/2023) (PDF) Solution Deployed In Progress 9/30/2023

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

Billing Opportunities

Issue Provider Type Guidance

 

  

 

 

Recovery Cancelled

Project Number Project Title Impacted Provider Types Original Recovery Date
       

 

 

CPT® is a registered trademark of the American Medical Association