Claims processing problem fixed

Claims processing problem fixed

The Indiana Health Coverage Programs (IHCP) has fixed the system issue identified in the News and Announcements article posted on October 24, 2014. The issue caused some claims to pay or deny in error with the following National Correct Coding Initiative (NCCI)-related explanation of benefits (EOB) codes:

  • 4181 - Service denied due to a National Correct Coding (NCCI) edit
  • 4183 - Units of service on the claim exceed the medically unlikely edit (MUE) allowed per date of service
  • 4186 - This is a component of a more comprehensive service. Please resubmit the claim with the procedure code that most comprehensively describes the services performed
  • 9999 - Paid as billed

The issue affected claims submitted on or after October 16, 2014. Providers may have received inappropriate denials or incorrect payments on their Remittance Advice (RA) statements dated October 21, 2014, and October 28, 2014. To prevent any additional inappropriate claim denials or incorrect payments, HP began holding claims submitted on or after Tuesday, October 28, 2014.

Today, HP released for processing all claims that were being held. Providers can expect to see these claims appear on the Remittance Advice (RA) dated November 4, 2014. Claims previously processed that denied with the above EOBs are being reprocessed today and will appear on the November 4, 2014 RA. Claims previously processed and paid incorrectly will be mass adjusted; providers will not have to refile the claims. Providers will be notified when the mass adjustment date is determined.