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["\n\n\n\n\n","Molina Healthcare of Ohio \nClaims Payment Systemic Errors ",null,null,null,"April 2023"]
["The current Claims Payment Systemic Errors (CPSEs) are listed below. Resolved issues previously reported will be removed from this log, and may be found in archived reports. Please review the log for updates prior to contacting Provider Services at (855) 322-4079."]
["Unique ID and Description of CPSE","Date CPSE was First Identified","Billing Provider Type(s) Impacted by CPSE (select all that apply)","Timeline for Fixing CPSE","Date(s) and/or Date Span(s) of Corrected Claims Adjustments","CPSE Status"]
["Unique ID:228\nConfirmed CPSE:\nOverpaying VFC providers the administration and the vaccines billed and not limiting the payment to less of billed charges. ","2022-04-29","12-Federally Qualified Health Center\r\n21-Professional Medical Group\r\n01-Hospital (IP & OP)","2023-03-31","Workaround started 6/8/2022\nRecoveries ETA  5/30/2023","Fix is complete"]
["Unique ID:250\nConfirmed CPSE:\nClaims hitting edit 151 for invalid POS in error","2022-11-28","95-ODADAS Certified/Licensed (SUD) Treatment Program\r\n84-Ohio Department of Mental Health (Community Mental Health) Provider ","2022-11-29","Batch 1 Adjustment Completed 2/2/2023\nBatch 2 Adjustment Completed 2/2/2023\nBatch 3 Adjustment Completed 4/6/2023\nBatch 4 Adjustment Completed 4/6/2023","Completed"]
["Unique ID:252\nConfirmed CPSE:\nAfter an Optum release version on non-behavioral health claims or non COVID19 related claims, billed with vaccine and/or vaccine administration codes were incorrectly set to price only with modifier HE.","2022-12-06","01-Hospital (Outpatient)","2022-12-08","Adjustment Completed 3/16/2023\nRecoveries Completed 3/22/2023 ","Fix is complete"]
["Unique ID:254\nConfirmed CPSE:\n2023 the AMA released the update to advise changes to E/M services, including observation care services; Effective 01/01/2023. Deletion of observation CPT codes (99217-99220, 99224-99226) and merged into the existing hospital care CPT codes (99221-99233, 99238-99239). Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and Revision of Consultations E/M codes 99242-99245 and 99252-99255. Cotiviti system not updated yet with place of service change for Edit 6084 DP 3049. ","2023-02-01","21-Professional Medical Group","2023-02-10","Adjustment completed 3/24/2023","Completed"]
["Unique ID:256\nConfirmed CPSE:\nCorrecting claims payment to align to the retroactive rate change ODM sent for EAPG and OPHBH Monkey Pox Updates.","2023-01-18","01-Hospital (Outpatient)","2023-01-18","Adjustment completed 3/1/2023","Fix is complete"]
["Unique ID:259\nConfirmed CPSE:\nClaims are being incorrectly accepted/rejected when providers should have been advised to “resubmit” through one front door.","2023-02-13","01-Hospital (Outpatient)\r\n16 & 60-Home Health Agency\r\n21-Professional Medical Group","2023-04-11","ETA 8/12/2023","Fix is complete"]
["Unique ID:260\nConfirmed CPSE:\nMCPF Solution went live causing Medicaid and MMP Medicare claims to deny in error which also impacted MMP Medicaid claims.","2023-02-21","00-All provider types","2023-02-23","Batch 1 Adjustment completed  3/29/2023\nBatch 2 Adjustment ETA 3/14/2023-4/25/2023\nBatch 3 Adjustment completed 4/12/2023","Fix is complete"]
["Unique ID:261\nPotential CPSE:\nThe Central Medicare Unit (CMU) closed submitted authorization requests stating no authorization is required for services for the first three 30-days, this only applies for Medicare billed services. This caused the Medicaid billed services to deny in error. Codes G0151, G0152, G0153, G0156, G0299, G0300 and T1000.","2023-02-27","16 & 60-Home Health Agency","ETA 6/27/2023\nPartial Fix G0156  2/28/2023","Workaround started for G0156 2/28/2023\nETA 8/26/2023\n","Ongoing \nremediation"]
["Unique ID:263\nPotential CPSE:\nPaper Claims that were received and submitted to Change Health Care, the clearing house is changing the Insured and Subscriber information causing Molina claim to reject for Member Not Found in error.","2023-01-24","00-All provider types","2023-04-04","ETA 8/30/2023","Fix is complete"]
["Unique ID:264\nConfirmed CPSE:\nClaims denied for benefit limit exceeded in error due to incorrect configuration loaded for benefit accumulation. \n","2023-02-01","76-Durable Medical Equipment Supplier\r\n95-ODADAS Certified/Licensed (SUD) Treatment Program\r\n84-Ohio Department of Mental Health (Community Mental Health) Provider ","2023-02-01","Batch 1 Adjustment ETA 4/3/2023-5/15/2023\nBatch 2 Adjustment ETA 4/3/2023-5/15/2023","Fix is complete"]
["Unique ID:265\nNew Confirmed CPSE:\nHCPCS Code, C8929, was incorrectly denying for prior authorization required when no prior authorization was needed.","2023-03-13","01-Hospital (Outpatient)","2023-02-23","Adjustment ETA 3/28/2023-5/9/2023","Fix is complete"]
["Unique ID:266\nNew Potential CPSE:\nCPT codes G0316, G0317 and G0318 are denying in error hitting Edit 9521 (ONLY ONE EVALUATION AND MANAGEMENT CODE AT THIS SERVICE LEVEL IS COVERED DURING THE COURSE OF CARE).","2023-03-21","21-Professional Medical Group","ETA 7/19/2023","ETA 9/17/2023","Ongoing \nremediation"]
["Unique ID:267\nNew Potential CPSE:\nClaims are denying in error for PA when billed with Place of Service 31 for Non-Par Providers.","2023-03-23","00-All provider types","ETA 7/21/2023","ETA 9/19/2023","Ongoing \nremediation"]
["Unique ID:268\nNew Potential CPSE:\nThe National Physician Fee Schedule (NPFS) updated the PC/TC indicator for dental codes from \"9\" to \"5\" effective 1/1/2023. Indicator 5 allows facilities to bill dental codes. CES incorrectly started to deny ASC facility claims reported on HCFA 1500 forms in error. Modification has been submitted to exclude ASC facility specialties to allow for correct reimbursement.","2023-04-04","46-Ambulatory Surgery Center","ETA 8/2/2023","ETA 10/1/2023","Ongoing \nremediation"]