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