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Fiscal Agent Name Change: References to the current fiscal agent will now be DXC Technology (DXC), due to the Enterprise Services business of Hewlett Packard Enterprise (HPE) merging with Computer Sciences Corporation (CSC) to form DXC.
Suspended claims only show up once on the Remittance Advice (RA). The claim won’t appear again on the RA until the claim either denies or pays. Once the claim is finalized, it will be reported on the RA and the 835. Suspended claims are not reported on the 835, only on the RA.
For claims that are processed (and receive a status of Paid) by 6 p.m. each Friday:
Remember – if you updated your EFT information recently, you will receive paper checks for the following two weeks.
RAs will be available for download every Monday morning, by 12 p.m. MST. Review this RA quick guide to learn more.
835 Availability: 835s will be available the Thursday following the Friday financial cycle. Review this 835 quick guide to learn more.
Follow these instructions to see which account you’re logged into. There are also instructions for changing your display name, to make it easier to identify which account you’re logged into going forward.
The Provider Services Call Center has increased staffing to accommodate the call volume from providers. Due to the extra staffing, the call center is seeing minimal wait times. Claims, EDI, and other provider questions should be directed to the Provider Services Call Center (1-844-235-2387).
Procedure codes J7297 (Liletta) and J7302 (Mirena) were not being processed for payment. This was affecting obstetrics claims returning EOB 1178 – “Service not reimbursable for DOS (dates of service).
Both procedure codes are part of the 2016 HCPCS update which was complete on 7/14/17.
Procedure code J7302 (Mirena) is not a valid procedure code after 12/31/2015. Procedure code J7298 should be used in its place.
Claims were reprocessed by DXC on 7/14/17.
Issue resolved 7/12/17
UPDATE 8/8/17: Although the 2016 HCPCS were loaded procedure code J7297 (Liletta) is denying for EOB 1178. DXC is working to fix the issue. Providers will need to resubmit these claims once this issue has been resolved. Providers should submit claims as necessary in order to meet the requirements for timely filing.
Clinic claims for non-EPSDT services are incorrectly denying for EOB 0678 – “Billing Provider Type and Specialty is not allowable for the Rendering Provider” when a Certified Registered Nurse Anesthetist (CRNA) or a Podiatrist is listed as the rendering provider. Clinic providers are allowed to bill non-EPSDT services for these provider types.
DXC is working to fix the issue.
DXC and the Department are working to determine whether claims can be reprocessed. Providers should submit claims as necessary in order to meet the requirements for timely filing.
Claims for clinic providers are incorrectly denying for procedure code 99406. These claims are denying for EOB 1381 - "No billing rule for procedure." Clinic providers are allowed to bill for this code even if the member is not pregnant.
DXC is working with the Department to fix the issue.
Providers will need to resubmit these claims once this issue has been resolved. Providers should submit claims as necessary in order to meet the requirements for timely filing.
Claims for DME providers are incorrectly denying for EOB 2368 – “DME Rent to Own - Purchase Price limit” for the following procedure codes: B9000, B9002, B9004, B9006, E0193-E0194, E0202, E0445, E0462, E0500, E0603, E0619, E0691-E0694, E0720, E0730, E0762, E0770, E0779-E0780, E0935, E1841, E2402, K0462 and S9001.
This issue is affecting Professional and Professional Crossover claims.
Providers should submit claims as necessary in order to meet the requirements for timely filing. Claims will be reprocessed by DXC.
Claims for Provider Type 16 (Clinic – Practitioner) are incorrectly denying when a well child visit and a sick child visit have been billed for the same day. These claims are denying for EOB 0030 – “EPSDT services are not a benefit with office visits.”
Procedure codes 99201 – 99215 with modifier 25 should be allowable against procedures codes 96360-96361, 99381-99385, 99391-99395 regardless of modifiers. Procedure codes 96360-96361, 99381-99385, 99391-99395 regardless of modifiers should be allowable against procedures 99201-99215 with modifier 25.
DXC is working to fix the issue. Claims will be reprocessed by DXC.
Claim denials for Explanation of Benefits (EOB) 2580 – “The services must be billed to the HMO/PHP listed on the eligibility inquiry” may appear for a medical or mental health service. The definition of Health Maintenance Organization (HMO) or Managed Care Organization (MCO) now includes Behavioral Health Organization (BHO). In the previous MMIS, there was an EOB code for HMO and a separate EOB code for the BHO. The new Colorado interChange combines these two EOB codes into one. Providers may see this EOB code when there is an HMO, Prepaid Health Plan (PHP), or BHO listed on the eligibility inquiry. DXC and the Department are working to update the description of this EOB code to more clearly define the EOB.
If the client has a BHO listed on the eligibility inquiry, providers should refer to the 2017 Uniform Service Coding Standards Manual to verify that the services are covered under the BHO. If the services are listed as covered by the BHO, providers should bill to them.
This issue is affecting all claim types with the exception of Home and Community Based Services (HCBS).
The Department and DXC are aware that some claims are continuing to deny incorrectly for hospital providers. DXC is working to resolve this issue.
Claims for Provider Type 48 - Rehab Agency are denying for some services that should be allowed for this provider type. These claims are denying for EOB 0182 – “Billing Provider Type and/or Specialty is not allowable for the service billed.”
DXC is working to fix the issue. Claims will be reprocessed by DXC.
DXC is working with the Department to closely review duplicate claims to ensure proper payment.
Current Anesthesia policy reimburses claims based on fifteen minute time units where any fractional unit of service is rounded up to the next fifteen minute increment.
The interChange is currently pricing fractional units without rounding up to the next fifteen minute increment. The Department is aware of this issue and is working on a system solution. Please continue to submit claims normally and the Department will resubmit affected claims once the issue is resolved.
Radiology providers enrolled as Type 16 – CLINIC are receiving claim denials when submitting claims with the CPT codes in the 70000 range resulting in EOB 1381 – “No billing rule for procedure.”
The Department is reviewing this matter and working on a solution. Claims will be reprocessed by DXC.
Secondary Claims with TPL information were incorrectly denying for EOB 4000 – “The member has other insurance. Bill the charges to the other insurance before billing Medicaid. Complete the other insurance payment information fields on the claim and retain a copy of the explanation of benefits.”
As an interim solution, starting 6/5/17, claims will suspend for review rather than deny. During this time, providers may see the claim temporarily suspend for EOB 4000, but no action is required. Claims will be adjudicated appropriately by DXC. DXC is working on a permanent fix.
In order for claims prior to 6/5/17 to be processed correctly, providers are asked to resubmit any claims denying for 4000 that included TPL information.
Claims are denying when a male baby is receiving gender-specific services such as circumcision, and the claim is being submitted with the mother's Medicaid ID. This is due to the mother's gender not matching the baby's. This is affecting claims where the gender-specific service is identified by either procedure or diagnosis codes.
This could be causing claims to deny for any of the following EOBs:
Diagnosis/Gender related errors - 0801, 1100, 1105, 1106, 1107, 1108, 1109, 1120, 3241, 3242, 3243, 3244, 4192, 7310, 7316, 7322, 7328, 7334, 7340, 7346, 7352, 7358, 7364, 7370, 7376, 7382, 7388, 7394, 7400.
Procedure/Gender related errors - 3290, 1281
If the mother and baby are together in the hospital, providers should continue to submit claims under the mother’s Medicaid ID; once either member is discharged the baby’s Medicaid ID should be used. Please note that at this time, the UK modifier cannot be used to identify that the claim is for the baby and not the mother.
DXC and the Department are reviewing this issue. An estimated resolution date has yet to be determined.
Currently co-pays on claims billed by clinic providers are not being deducted appropriately. DXC and the Department are working to fix the issue. Claims will be reprocessed by DXC and funds will be recouped. Additional details and recoupment dates will be provided as this information becomes available.
Procedure codes 97161 through 97168 are not correctly added to the clinic billing contract for provider types 25 (Non-Physician Practitioner Group) and 48 (Rehab Agency), and the practitioner billing contract for provider types 17 (Physical Therapist) and 28 (Occupational Therapist).
This has been causing claim denials with EOB code 0182. The Department is in the process of correcting this error and DXC will reprocess all denied claims since January 1, 2017, when the codes were opened.
When a rendering provider within a group has more than one (1) provider program ID associated with a National Provider Identifier (NPI), the claim will be denied or suspended.
DXC is working to merge provider records so there is only one program provider ID for each rendering individual. On May 4th, a system enhancement was implemented to populate the rendering provider that is affiliated with the billing provider. This allows the claim to be processed by DXC. For more information regarding the rendering provider system enhancement, please contact the Provider Services Call Center (1-844-235-2387).
The system is currently denying crossover claims for services that are covered by Medicare but not Medicaid.
The interChange should reimburse these claims based on the Medicare assigned coinsurance and deductible.
We are working on a fix but do not have an ETA yet. Please continue to submit these claims, and resubmit them once issue is resolved.
Provider Web Portal users are receiving the following error message upon submitting a Provider Maintenance Request with a Location Name that is greater than 30 characters: “Error: A failure occurred during a database insert. Location Name must be less than or equal to 30 characters in length.” Please note that in this context, “Location Name” refers to the Pay To Name field and/or the Mail To Name field. This error message appears even if no changes have been made to the Name or Address fields. This is occurring due to a data conversion issue with transferring location names longer than 30 characters from the previous MMIS into the new Colorado interChange system.
In order to bypass this error, portal users must take the following steps:
1. From within the Provider Maintenance Request in the portal, go to the Address Changes panel
2. Update the Pay To Name field (as shown under the Billing drop-down) to a value that is less than 30 characters
3. Update the Mail To Name field (as shown under the Mailing drop-down) to a value that is less than 30 characters.
After these changes are made, any other field(s) within the maintenance record can be updated as needed before submitting.
DXC is working to fix the issue.
There is no field currently available for Physician and Osteopath providers to input CLIA information. This applies to both the initial enrollment as well as enrollment updates on the Provider Web Portal. As a result, claims may be denying for EOB 3660 – “The service is not within the scope of the billing provider’s CLIA certification; Please update the MMIS provider records with the correct CLIA number”. Providers will not be able to update the CLIA information until the issue is resolved. Individuals within a group do not need to enter a CLIA.
DXC is working to fix the issue.
Providers will need to resubmit affected claims once this issue has been resolved. Providers should submit claims as necessary in order to meet the requirements for timely filing.
The Secure Correspondence tool in the Provider Web Portal may not display responses from DXC in the Correspondence area if the DXC agent marked the Call Tracking Number (CTN)* as closed. If a CTN is marked as closed, DXC responded to the inquiry, but the response message may not have populated.
As a workaround until the issue is resolved, DXC is now responding to Correspondence messages without closing the CTN. This will allow the portal user to view DXC’s response. Once the issue is resolved, DXC will close these CTNs and any responses that previously did not populate will be restored.
Portal users may also notice multiple lines associated with a single CTN in the Correspondence area. This is due to more than one response being sent by the DXC agent. If there is more than one line for a single CTN, only the latest response from DXC will appear.
DXC expects these issues to be resolved within the next 1-2 weeks.
*Note: Although the Secure Correspondence tool is for written communication rather than by phone, Secure Correspondence messages are given CTNs for tracking.
The Provider Web Portal displays physical and occupational therapy (PT/OT) total dollars and service units “used” from claims processed in the interChange system only (claims processed on or after 3/1/17). Dollars and service units used in the legacy MMIS system are not calculated into the amount displayed on the web portal, however, they are still counted towards limits when claims are adjudicated. The amounts displayed on the portal may not reflect the total amount of units the member has used.
DXC is working to add the above clarification to the portal where the Limit Details are displayed.
A Provider Web Portal error is occurring where the provider is attempting to change the rendering or referring provider on the Service Detail line of a claim after the initial entry, but the portal does not save the change.
Until the issue is resolved, if the Provider wishes to modify the entry, the line should be removed and re-entered. The line can be removed by clicking Remove in the Action column or clicking the Reset button at the bottom of the window.
DXC is working on resolving the issue.
Some Provider Web Portal users have experienced an intermittent “Error” message asking them to “try again later” when trying to submit claims. DXC believes a combination of internal factors in the DXC system along with external factors with the user’s network/internet connection is causing the problem. While DXC is still working to resolve this issue, the following steps have proven helpful to several users:
- Clear your browser’s cache
- Run a connection speed test
- Log out and come back at a later time - even a few minutes may help
- Use the system during non-peak hours (peak hours are 7 a.m. to 4 p.m. Monday through Friday)
- Try using another browser (Internet Explorer is the recommended browser)
If this does not resolve the issue, please call the Provider Services Call Center (1-844-235-2387) and press the option for “web portal”. Please let the agent know you have tried the suggestions above and provide them with your log on ID, Provider ID, an explanation of what you were doing on the portal at the time of the error and contact information for follow-up.
An estimated resolution date has yet to be determined.
If the code does not appear after searching with the entire 10-digit NDC, providers should submit the claim via paper or batch claim. Codes are updated on a monthly basis, so providers can attempt the search again after the 15th of each month.
DXC is looking into a solution for the issue. An estimated resolution date has yet to be determined.
When adding Third Party Liability to a claim in the Provider Web Portal, providers cannot type in the carrier name.
There are approximately 4300 carrier options available, but if the member’s carrier isn't one of the options, providers are unable to submit the claim correctly.
If the member’s carrier name isn’t available in the Provider Web Portal, providers should submit the claim and carrier information via Paper Claim or via Batch. Both of these options will allow for the free form entry of a carrier name.
Please review this document for work-around details.
Some members are being enrolled in Denver Health incorrectly. As a workaround, impacted members should contact Maximus (303-839-2120, or 888-367-6557; TTY 888-876-8864) to speak with an agent who can research to confirm their eligibility information and then initiate a correction as appropriate.
There is a system issue which prevents the Colorado interChange from processing some retroactive changes to a Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) member’s eligibility span.
If a member believes a fix to their eligibility information is necessary, the process is the same as it would have been with the old MMIS; the member must call the Health First Colorado Member Contact Center to initiate the correction.
If the member has already contacted the Member Contact Center and obtained the Proof of Insurance, the provider should accept this as eligibility verification and render services. The eligibility update will take 2-3 business days to appear in the Colorado interChange. Once the fix is made, the provider will be able to submit or resubmit claims for services to the member. For more detailed information, please refer to this fact sheet.
Some members were incorrectly showing as “incarcerated” in the interChange system. This issue was fixed, but in some very limited cases, members may still be listed incorrectly as incarcerated in the system.
Pharmacists should call Magellan at 1-800-424-5725 to confirm whether the system is incorrectly showing someone as incarcerated.
Issue resolved 5/1/17
The Colorado interChange system was not updated with the Colorado-specific Enhanced Ambulatory Patient Group (EAPG) schedule settings. Claims processed since the transition to Colorado interChange were processed under the default EAPG settings which may have resulted in inaccurate payments.
Claims will be reprocessed by DXC in November 2017. All claims submitted after 7/17/17 should pay correctly.
Issue resolved 7/17/17
Claims with the following procedure codes were suspending for EOB 2861 – “No Rate on File for the Date(s) of Service.”
This issue has been resolved and claims were recycled by DXC on 8/4/17.
Procedure codes have been listed by the affected provider communities below.
DME: E0486, E0635, E0639, E0676, K0462, L8699, S0395Laboratories: 89259, 81205, 81281, 81287, 81355Physician Services: 26418, 59898, 69631, 90662, 99100, 99135, 99140, 99288, 01996, G0452, J1050, J3490, J8499, Q2039, S0316, S0613, S4993, S9083, S9088, S9141 Vision: S0590, V2702, V2790
Issue resolved 8/3/17
All claims processed from 12:00 a.m. to 9:00 a.m. MDT on 8/11/17 suspended for EOB 0000 - "This claim/service is pending for program review." The issue is now resolved and the affected claims will be reprocessed by DXC. Providers can expect to see those claims in the correct status after the 8/11/17 financial cycle is complete.
Issue resolved 8/11/17
After the transition to the new Colorado interChange system outlier days were not calculated for payment. This issue was resolved on 3/9/17 however, inpatient claims that were originally processed between 3/1/17 and 3/9/17 may not have paid the outlier days.
Providers are advised to resubmit the affected claims.
Issue resolved 3/9/17
Claims with procedure codes 99221-99233 were denying for EOB 0010 – “The number of hospital visits exceeds the guidelines for the procedure billed” when the same service for a member was performed by different rendering providers in an outpatient setting.
Providers are advised to resubmit affected claims.
Issue resolved 8/2/17
Claims for Clinic and Non-Physician Practitioner Group providers were incorrectly denying for procedure code J3121. These claims were denying for EOB 1381 - "No billing rule for procedure."
Claims were reprocessed by DXC on 7/26/17.
Issue resolved 7/20/17
Claims for Clinic providers were incorrectly denying for procedure code 97162. These claims were denying for EOB 1381 - "No billing rule for procedure."
Claims will be reprocessed by DXC.
Issue resolved 7/27/17
Professional and Outpatient claims were incorrectly denying for EOB 0101 – “This is a duplicate service.” However, this is a valid denial in the case of duplicate laboratory codes.
Claims were reprocessed by DXC on 7/21/17.
Issue resolved 7/12/17
Claims for Provider Type 25 - Non-Physician Practitioner Group were denying for some services that should have been allowed for this provider type. These claims were denying for EOB 0182 – “Billing Provider Type and/or Specialty is not allowable for the service billed.”
There was an issue with Evaluation and Management (E/M) codes in the Colorado interChange (for example, procedure codes 99201-99215). E/M codes with either modifier GT or FP were not affected, but should only be applied to appropriate claims.
Some provider rates were inadvertently end dated on June 30, 2017. This was causing claims to deny (from July 1 forward).
Affected claims were denying for EOB 0182 – “Billing Provider Type and/or Specialty is not allowable for the service billed.”
After identifying the issue, DXC suspended claims until it was resolved.
Claims that denied or suspended were reprocessed by DXC in the 7/28/17 financial cycle.
This fix does not address the issue affecting Rehab Agencies (provider type 48). For more information on this issue, please refer to the “Claim Denials for Provider Type 48 for EOB 0182 - Rehab Agency” posting.
Issue resolved 7/24/17
If a Medicaid ID was used to add a provider affiliation update, users were receiving an error. The error message reads, “NPI contains invalid characters,” however, this did not clearly describe the issue. This error message was meant to indicate that providers must use their NPI, not the Program provider ID. Providers were previously advised that if the NPI is shared between multiple locations, the magnifying glass could be used to select the appropriate provider.
DXC has updated this error message to: “Selected provider ID must be an NPI.” DXC also changed the label of the “Provider ID” field, used when creating an affiliation, to “Provider NPI.”
Issue resolved 7/13/17
A Provider Web Portal error message was displaying when a provider attempted to add duplicate ICD surgical procedures on an Institutional claim, even if the dates of the procedure were different. The error message stated, “Surgical Procedure Code already exists in the list.”
Providers were previously advised that if they have a batch biller they could submit claims via batch.
When submitting a service detail line for a vaccine in the Provider Web Portal, providers were required to enter a dollar amount even though vaccines should not require this amount.
In addition, there was an existing known issue where the NDC for the DTaP vaccine was is not available in the Provider Web Portal.
As a workaround until the issue was resolved, providers were instructed to submit a vaccine detail line or a detail line that contains the NDC for DTaP via paper or batch claim.
Issue resolved 7/5/17
Claims for the following HCPCS/CPT service codes were denying incorrectly for EOB 0192 – “Prior Authorization (PA) is required for this service. An approved PA was not found matching the provider, member, and service information on the claim.” This is was due to a system error, as these codes do not require a prior authorization. This issue was is primarily affecting Physician and Optician provider types.
Providers were previously instructed to should submit claims as necessary in order to meet the requirements for timely filing.
Providers are now advised to resubmit affected claims.
Issue resolved 7/3/17
Provider types FQHC, RHC and IHS were experiencing a Provider Web Portal issue where they were required to enter a dollar amount above $0.00, even when not applicable for the service provided. The portal did not allow for the service detail line to be itemized at $0.00. These claims were denied.
Providers are advised to resubmit affected claims.
A web portal error was preventing providers from viewing some claims in the Claims panel => Search Claims. After clicking on a specific claim in the search results, the portal returned the following error message: “There was an issue processing your request. We apologize for any inconvenience this may have caused…”
Issue resolved 7/10/17
Adjustments to Professional and Professional Crossover claims were incorrectly denying for EOB 1336 – “Header to date of service is required”. This EOB code was only appearing on adjustments, not on new claims.
Claims were reprocessed by DXC on 6/29/17.
Issue resolved 6/21/17
Claims were denying for EOB code 1030 - “The place of service code is invalid for procedure code.” Place of service (POS) 11, 19 and 20 were not set up for all appropriate procedure codes.
DXC and the Department have added a large volume of codes to allow providers to use these three POS.
Issue resolved 6/12/17
Some HCBS and DME claims were incorrectly suspending for BHO level edits.
Providers are advised to resubmit claims that were suspended for EOB 3026.
Issue resolved 5/18/17
If a provider submitted a $0 deductible on a claim, and the Medicare deductible had been met, claims were incorrectly denying for EOB 3620 - “The Medicare deductible on the claim is greater than annual amount. The deductible amount must match the amount on the Medicare explanation of benefits. Correct the deductible amount.”
Claims were reprocessed by DXC on 7/3/17.
Issue resolved 6/10/17
Procedure code J9267 was denying for EOB 1381 – “no billing rule for procedure”. Claims were reprocessed by DXC on 7/10/17.
Issue resolved 6/15/17
Some Provider Web Portal users were experiencing an issue where the NPI was entered, but the web portal switched it to the Medicaid ID, resulting in claim denials for EOB 0966 – “The rendering provider is not eligible at this location on date(s) of service.” This was occurring on Institutional, Professional and Dental claims for the following associated provider IDs: Referring, Supervising, Service Facility Location, and Rendering. NPIs for Billing Providers were not affected. Batch claims were not affected. This issue was isolated to web portal claims.
The following workaround was provided while DXC was working on the fix: “Click the magnifying glass icon next to the provider ID field. The provider can search for the correct provider ID and select it to ensure the NPI is retained.”
Providers are advised to rebill claims that denied for EOB 0966.
Issue resolved 5/24/17
Inpatient/outpatient claims using a diagnosis from a mental health diagnosis group or substance use disorder group were incorrectly denying for EOB 2580 – “The services must be billed to the HMO/PHP listed on the eligibility inquiry.”
These claims have been reprocessed.
Issue resolved 6/1/17
Claims with procedure code 90746 were suspended for EOB 0653.
Claims were reprocessed by DXC on 6/15/17.
Issue resolved 6/7/17
An address in Lamar, Colorado was populated on many provider’s claims. This address may not have correlated to the member’s address on file.
Issue resolved 5/5/17
Claims submitted with valid CLIA licenses were incorrectly denying for EOB 3660 – “The service is not within the scope of the billing provider's CLIA certification. Please update the MMIS provider records with the correct CLIA number”. These claims will be reprocessed.
Providers that submit lab claims without having a CLIA license on file or with an expired CLIA license will continue to deny. Providers should ensure all current CLIA information is added in Provider Maintenance and a copy of the CLIA license is attached on the last page. The update request must be approved before denied claims can be resubmitted.
1. This EOB message was appearing in cases where the procedure code was manually priced on the Prior Authorization Request (PAR). Procedure codes affected include: A0100, S5160, S5161, S5165, S5185, T2016, and T2029.
All PARs have been updated and claims have been reprocessed by DXC. PARs with level 7 residential rates for codes T2016 and T2021 have been corrected. Providers should rebill claims for these two codes.
Moving forward, please be aware that if the claim denies for 0653, there may not be a PAR on file. Please check to make sure there is an approved PAR for the claim.
2. This EOB message will also post if the claim requires an invoice to price the claim, such as DME supplies or unspecified medical procedures. DXC is manually working these claims as they come in.
Issue resolved 5/19/17
Providers were experiencing an issue where they were unable to submit PETI PARs due to the member information not populating the page as expected. A workaround was provided while DXC was working on the fix.
Issue resolved 5/17/17
Some providers were receiving a “Member not found” error message when trying to submit a claim. A workaround was provided while DXC was working on the fix.
Issue resolved 5/17/17
Health First Colorado Members were incorrectly showing eligibility coverage for both Title 19 as well as child health plan plus.
Issue resolved 5/18/17
Trading partners were experiencing a DNN error when trying to download a file through the portal.
While this issue is now resolved, trading partners are encouraged to use Secure File Transfer Protocol (SFTP). Instructions can be found in the Connectivity Guide, available on the EDI Support page.
Issue resolved 5/18/17
Hospital back up claims for nursing facilities were suspending for EOB 1340 – “Reimbursement rate is not on file for provider.” The rate has now been loaded and all suspended claims have been reprocessed by DXC.
Issue resolved 5/17/17
Claims for prosthetics for podiatry services submitted with the following codes, prior to 4/20/17, were denying for EOB code 1381:
L1904, L1940, L1970, L2275, L2280, L2330, L2340, L2820, L3000, L3020, L3030, L3060, L3100, L3150, L3201, L3216, L3221, L3260, L3320, L3480, L4361, and L4396.
DXC will be reprocessing all denied claims for providers. Reprocessed claims are expected to be on the 5/15 Remittance Advice (RA). However, if providers wish to resubmit for payment sooner they may do so.
Issue resolved 4/20/17
All inpatient and outpatient claims that posted this error have been reprocessed and will appear on the 5/15/17 RA. Hospice providers may continue to receive this denial.
Issue resolved 5/9/2017
Claims for vision supplies, like eye glasses, were denying due to missing vision codes for EOB 0653 – requires manual pricing. These codes were loaded on 5/5/17 and claims will be reprocessed by DXC on 5/12/17.
Issue resolved 5/12/17
Revisions to Prior Authorization Requests (PARs) transmitted from eQHealth were processing incorrectly following the transition to the new system, causing approvals to be delayed.
Issue resolved 5/1/17
Issue resolved 4/28/17
Issue resolved 4/22/17
Issue resolved 4/17/17, please refer to this email for more detail.
A large portion of Procedure codes were not set to pay for the provider types above. The issue was resolved 4/5/17, and providers should resubmit any denied CMS 1500 claims.
Please refer to this email for more detail.
Some providers were receiving an error message when they tried to register for their Web Portal account. Providers were instructed not to use spaces in their display name as a work-around.
The issue was resolved on 3/28, and providers may use spaces in their display names.
Issue Resolved 3/19/17. Affected claims have been recycled by DXC. No further action required.
Nursing Home Patient Liability was incorrectly deducted. System was using patient liability from CBMS to auto deduct when a claim goes through. However, instead of deducting the liability amount once for the month, it deducted every time a claim was submitted.
Issue resolved. Patient liability now deducting correctly. Claims where patient liability was incorrectly deducted were adjusted by DXC on 3/17/17.