Known Issues and Resolution Timeframes
Updated 8/22/2023
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, please let us know the claim number so that we can research it and confirm. You may email us or contact your Provider Relations Rep.
Open Issues
| OPEN ISSUE DESCRIPTION | IMPACTED PROVIDER TYPE | TIME PERIOD | ISSUE DETAILS | ISSUE RESOLUTION STATUS | CLAIM PROJECT STATUS | TARGET COMPLETION DATE |
|---|---|---|---|---|---|---|
| Codes 64615 and J0588/J0585 | Medicaid | Post 4/1 DOS | Codes 64615 and J0588/J0585 Details (PDF) | Solution Identified | Project in Process | n/a |
| TOB 851 Issues | Meridian Complete | Post 4/1 DOS | TOB 851 Issues Details (PDF) | Solution Identified | In Process of Project Creation | TBD |
| J3380 Pricing Not Available | Medicaid | POST 4/1/22 DOS FOR 2022 ONLY | J3380 Pricing Not Available Details (PDF) | Solution Identified | Project in Process | TBD |
| Fractional Mileage | Medicaid | Post 4/1 DOS | Fractional Mileage Details (PDF) | Solution Identified | Project in Process | TBD |
| Critical care codes w/ Mod 27 | Medicaid | POST 4/1/22 | Critical care codes with Mod 27 Issue Details | Full Resolution Deployed | In Process of Project Creation | TBD |
| ER Downcoding reprocessing paying $0 | Medicaid | POST 4/1/22 | ER Downcoding Reprocessing Issue Details |
Solution Identified | Under investigation | TBD |
| FQHC/RHC Antepartum Codes paying at the wrong rates | Medicaid | POST 4/1/22 | FQHC/RHC Antepartum Codes Issue Details | Solution Identified | In Process of Project Creation | TBD |
| Issue Key | Issue Resolution Status |
|---|---|
| Research | Issue under investigation to determine root cause |
| Solution Identified | Issue has been identified, but no system updates (to date) have been made |
| Full Resolution Deployed | Issue has been corrected in the system and all of the system updates have been made |
| Claim Key | Claim Project Status |
|---|---|
| In Process of project creation | Project under investigation to determine affected claims and providers |
| Project in Process | Claim project has been initiated, provide payment will begin within next 7 days |
| Project Complete | Claims included in the claim project have reprocessed. Note, this is not a guarantee of payment, during reprocessing claims may hit additional claim edits |
For questions about global issues or the associated claims projects, please contact Provider Services or your Provider Relations Rep.
Special Projects in Process
| Special Project Name | Project Description | Estimated Claims Processing Date | Actual Claims Completion | Project Number |
|---|---|---|---|---|
| n/a | n/a | n/a | n/a | n/a |
Recovery Projects
Recovery notice letters to be mailed to providers within 30 days of the project being submitted, followed by a 60-day notice period, during which providers can decide if they want to mail Meridian a refund check or allow the claims to be recouped automatically at the end of the 60-day notice period.
| Recovery Project Name | Project Description | Recovery Estimated Completion Date | Notification Letters Sent | Project Number |
|---|---|---|---|---|
| n/a | n/a | 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. You may email us or contact your Provider Relations Rep.
| COMPLETED ISSUE DESCRIPTION | IMPACTED PROVIDER TYPE | IMPACTED CLAIMS SPAN | COMPLETION DATE |
|---|---|---|---|
| Doula Claim Denials | Medicaid | Post 4/1 DOS | 9/11/2023 |
| EXNT - Deny: Provider Not Contracted for Services Provided | Medicaid | Post 4/1 DOS | 9/18/2023 |
| DN132 Anesthesia | WellCare | 7/1/2022 - Present | 9/5/2023 |
| SNF claims paying room and board but denying ancillary (therapy) codes | Medicaid | Post 4/1 DOS | 9/8/2023 |
| Payment policy CC.PP.054 | Medicaid | Post 4/1 DOS | 8/15/2023 |
| Medicaid delivery denials for newborns | Medicaid | Post 4/1 DOS | 6/5/2023 |
| Incorrect MIHP Takeback | Medicaid | Post 4/1 DOS | 5/22/2023 |
| FQHC - Encounter Codes | Medicaid | Post 4/1 DOS | 4/21/2023 |
| EX4B:deny-service not reimbursable in location billed -this can be removed | Medicaid | Post 4/1 DOS | 4/21/2023 |
| Code D0190 Bundling Denials | Medicaid | Post 4/1 DOS | 4/20/2023 |
| CHAMPS Provider Enrollment Denials | Medicaid | Post 4/1 DOS | 4/15/2023 |
| Exga Denials for CPT 36455 | Medicaid | Post 4/1 DOS | 4/15/2023 |
| Underpayment issue due to CLIA | Medicaid | Post 4/1 DOS | 4/14/2023 |
| EXDZ Denials | Medicaid | Post 4/1 DOS | 4/7/2023 |
| High Dollar Level of Care EX1R (reduction code) | Medicaid | Post 4/1 DOS | 4/7/2023 |
| EX46 Denials | Medicaid | Post 4/1 DOS | 4/1/2023 |
| EXRD Denials | Medicaid | Post 4/1 DOS | 3/30/2023 |
| Chiropractic Codes - EXya/EXyb | Medicaid | Post 4/1 DOS | 3/16/2023 |
| Front end rejections related to Eligibility | Medicaid | Claims billed post 4/1 for DOS pre 4/1 | 3/15/2023 |
| Attending Provider Field on the Institutional Hospital Claim Format | Medicaid | 1/1/2022 - 3/31/2022 | 2/15/2023 |
| Exre - Referring provider is required on claim form | Medicaid | Ongoing | 2/8/2023 |
| G0466-G0470, G0463, G0480, G0451 denying for Exyw | Medicaid | Post 4/1 DOS | 1/18/2023 |
| Problem-Oriented Visits with Preventative Visits (WELL AND SICK VISITS) denying for EXpB policy CC.PP.057 | Medicaid | Post 4/1 DOS | 1/17/2023 |
| ACE/OCE Claim Level Edits and Denials | Medicaid | Post 4/1 DOS | 1/17/2023 |
| Missing Outliers/ UM leveling of Care | Medicaid | Post 4/1 DOS | 1/2/2023 |
| X-Rays - Code 92 | Medicaid | Post 4/1 DOS | 10/17/2022 |
| Codes 81420 and 8150 | Medicaid | 1/1/2022 – 3/31/2022 | 10/5/2022 |
| Invalid AMISYS Exy1 Denials | Ambetter | 1/1/2021 - Present | 8/25/2022 |