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 Relations Contact Form.
We appreciate your cooperation and patience as we work to resolve claims efficiently.
Project Name | Project Number | Project Notification Letter | Project Description | Impacted Specialties | Status | Estimated Completion |
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 |
Capitation Takeback Claim Recoupments | Multiple | MDHHS conducts monthly capitation takebacks for members that lose eligibility with Meridian. There is no date limit on how far back MDHHS can conduct capitation takebacks. Meridian is required to conduct a claims review for impacted members and recoup any paid claims from providers. The claims will be reset and denied with EX code 28 (member not eligible on date of service). **Update: MMP members that were in a deeming status on the date of service were included in these projects in error. The impacted claims have been delinked from the projects. Members in a deeming status on the date of service will be excluded from these projects going forward. | Multiple | In progress | Multiple | |
Paid claims but no eligibility/capitation | Multiple | Paid Claims with No Eligibility/Capitation Recoupment Notification | The purpose of this project is to recoup all paid Medicaid claims where members have no eligibility/capitation. This will be a monthly project, similar to capitation takebacks. | Multiple | In progress | TBD |
Project Name | Project Number | Project Notification Letter | Project Description | Impacted Specialties | Status | Completed Date |
|---|---|---|---|---|---|---|
DME Limits and Duplicate FTC Recoveries | PROJ-544726498 PROJ-540864403 PROJ-540854559 PROJ-540886536 PROJ-540889252 | DME and FTC Duplicate claims recovery project | See Notification | Complete
| 6/12/2025 | |
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 | Complete | 4/30/2025 | |
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 | Complete | 4/1/2025 & | |
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 | Complete | n/a |
Provider CHAMPS Rejections | Multiple |
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 | Complete | n/a | |
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 | Complete | 5/30/2025 |
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 | Complete | 2/11/2025 |
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 | Complete | 6/6/2025 |
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 | Complete | 8/14/2025 | |
Recoupment Project: Payments Without Authorization | PROJ-618466266 | Recoupment Project: Payments Without Authorization Notification | Claims are being paid in error when there is no auth on file, or the authorization was updated and there was no reprocessing performed. System updates were performed and education provided. | Skilled Nursing Facility (SNF) | Complete | 9/4/2025 |