Claims Project Status
Welcome to the Claims Project Status Page
To improve transparency and streamline communication, Meridian has created this page to provide real-time status updates on claims related projects. Here, you can easily track progress and access key details without the need for frequent follow-ups.
If your project is marked as “Complete” but the issue remains unresolved on your end two weeks after the indicated completion date, you may submit an escalation through a Provider Inquiry Form.
We appreciate your cooperation and patience as we work to resolve claims efficiently.
Current Claims Projects
Project Name | Project Number | Project Notification Letter | Project Description | Impacted Specialties | Status | Estimated Completion |
|---|---|---|---|---|---|---|
MDHHS Carve-Out Codes | PROJ-575528019 & PROJ-575527598 | Previously, these carve-out codes required prior authorization (PA) through MDHHS. Moving forward, they will be considered conditional services rendered through MDHHS Fee-for-Service (FFS). | See Notification | In Progress | TBD | |
DME | PROJ-544726498 | DME | See | In | 5/30/2025 | |
Invalid Provider Specialty for Claim Type Billed
| Multiple | Invalid Provider Specialty for Claim Type Billed Notification
| The purpose of this project is to recover claims where the referring/ordering/attending provider specialty is not valid for the claim type billed. These claims were paid and the associated Encounter rejected by MDHHS | Multiple | In progress | 5/16/2025 |
Provider CHAMPS Rejections | Multiple | Provider CHAMPS Rejections Notification
| The purpose of this project is to recover claims where the billing, referring, or attending provider NPI is not active in CHAMPS for the claims DOS. These claims were paid, and the associated Encounters were rejected by MDHHS. | Multiple | In progress | 5/16/2025 |
Diagnosis code inappropriate for age | Multiple | Based on the members date of birth, these claims were billed with diagnosis codes that are outside the age restriction per CHAMPS. These claims were paid in error, and the associated Encounters were rejected by MDHHS. | Multiple | In progress | 5/16/2025 | |
Retro terms due to incarceration (I), nursing facility placement (N), or death (D) | Multiple | Retro terms due to incarceration (I), nursing facility placement (N), or death (D) Notification | Meridian received retro terms on the 834 file from MDHHS for impacted members due to incarceration (I), nursing facility placement (N), or death (D). Meridian’s contract states that claims can be recouped prior to capitation being recouped for these disenrollment reasons. Any paid claims with dates of service after the retro term date will be reset and denied with EX code 28 (member not eligible on date of service). | Multiple | In progress | Multiple |
Updates to Billing Configurations & Recoupment Project - PROJ 546810384 | Project - PROJ 546810384 | Updates to Billing Configurations & Recoupment Project - PROJ 546810384 Details | The purpose of this project is to recover claims that were impacted by configuration updates. | Multiple | In progress | TBD |
Recoupment Project and Application of 'Lesser Of' Logic | PROJ-539331320 | Recoupment Project and Application of 'Lesser Of' Logic Details | The purpose of this project is to recover claims that were impacted by configuration updates to apply the “less of” logic to waiver provider payment rules. | Multiple | In progress | TBD |
Recoupment project of payments over authorized units of T1019 | PROJ-596412600 | Recoupment project of payments over authorized units of T1019 Details | Claims billed with T1019 were paid with no authorization on file. Due to lack of authorization, these claims need to be recouped. | Multiple | In progress | TBD |
MME Member Claims Paid as Primary in Error | PROJ-594438829 | An in-depth analysis was conducted on the claims for MME members to verify valid Medicare coverage and Medicare primary billing. | Multiple | In-Process | 07/30/2025 | |
Capitation Takeback Claim Recoupments | Multiple | MDHHS conducts monthly capitation takebacks for members that lose eligibility with Meridian. | Multiple | In progress | Multiple |
Project Name | Project Number | Project Notification Letter | Project Description | Impacted Specialties | Status | Completed Date |
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