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Known Issues and Resolution Timeframes

Updated 1/18/2023

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
Attending Provider Field on the Institutional Hospital Claim Format Medicaid  1/1/2022 - 3/31/2022 Details
(PDF)
Full Resolution Deployed Project in Process TBD
CHAMPS Provider Enrollment Denials Medicaid  Post 4/1 DOS Details
(PDF)
Full Resolution Deployed Project in Process 3/1/2023
COVID 19 Code 87811 Medicaid  Post 4/1 DOS Details
(PDF)
Full Resolution Deployed Project in Process 3/1/2023
DN132 Anesthesia WellCare 7/1/2022 - Present Details
(PDF)
Full Resolution Deployed In Process of Project Creation TBD
EX46 Denials Medicaid  Post 4/1 DOS Details
(PDF)
Solution Identified In Process of Project Creation TBD
EXDZ Denials Medicaid  Post 4/1 DOS Details
(PDF)
Full Resolution Deployed Project in Process TBD
Exrd Denials Medicaid  Post 4/1 DOS Details
(PDF)
Full Resolution Deployed Project in Process TBD
FQHC - Encounter Codes Medicaid  Post 4/1 DOS Details
(PDF)
Research n/a TBD
Front end rejections related to Eligibility Medicaid  Claims billed post 4/1 for DOS pre 4/1 Details
(PDF)
Full Resolution Deployed In Process of Project Creation TBD
G0466-G0470, G0463, G0480, G0451 denying for Exyw Medicaid  Post 4/1 DOS Details
(PDF)
Solution Identified In Process of Project Creation TBD
Medicaid delivery denials for newborns Medicaid  Post 4/1 DOS Details
(PDF)
Solution Identified In Process of Project Creation TBD
SNF claims paying room and board but denying ancillary (therapy) codes  Medicaid  Post 4/1 DOS Details
(PDF)
Solution Identified In Process of Project Creation TBD
X-Rays - Code 92 Medicaid  Post 4/1 DOS Details
(PDF)
Full Resolution Deployed Project in Process 2/1/2023

 

 

 

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 DETAILS IMPACTED PROVIDER TYPE IMPACTED CLAIMS SPAN COMPLETION DATE
Invalid AMISYS Exy1 Denials  PDF Ambetter 1/1/2021 - Present 8/25/2022
Missing Outliers/ UM leveling of Care PDF Medicaid  Post 4/1 DOS 1/2/2023
Problem-Oriented Visits with Preventative Visits (WELL AND SICK VISITS) denying for EXpB policy CC.PP.057 PDF Medicaid  Post 4/1 DOS 1/17/2023
ACE/OCE Claim Level Edits and Denials PDF Medicaid  Post 4/1 DOS 1/17/2023
Codes 81420 and 81507 PDF Medicaid  1/1/2022 – 3/31/2022  10/5/2022
Last Updated: 01/19/2023