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["\n\n\n\n\n","Molina Healthcare of Ohio \nClaims Payment Systemic Errors ",null,null,null,"July 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:261\nConfirmed 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","Partial Fix G0156  2/28/2023\nOverall Fix 06/27/2023","Workaround started for G0156 2/28/2023\nAdjustment (G0156) completed 6/1/2023\nAdjustment batch 2 ETA 7/11/2023-8/22/2023\n","Fix is complete"]
["Unique ID:269\nConfirmed CPSE:\nNew Marketplace fee schedule allowed payments for BH codes listed on the TPL bypass list to process for payment. Due to the new fee schedule and the configuration to allow those payments, claims that should pay as primary for 84/95 providers stopped paying as primary and only processed under the Medicaid line of business if Marketplace allowed patient responsibility resulting in the provider being underpaid.  ","2023-04-17","84-Ohio Department of Mental Health (Community Mental Health) Provider \r\n95-ODADAS Certified/Licensed (SUD) Treatment Program","2023-07-06","Workaround started 4/24/2023\n","Fix is complete"]
["Unique ID:270\nConfirmed CPSE:\nIT deployment on 4/11/2023 corrupted ruleset/post validations for UB04 claims causing bill type not to load.","2023-04-13","01-Hospital (IP & OP)","2023-04-20","Adjustment batch 1 ETA 6/30/2023-8/14/2023\nAdjustment batch 2 ETA 6/30/2023-8/14/2023\nAdjustment batch 3 ETA 6/30/2023-8/14/2023\n","Fix is complete"]
["Unique ID:271\nConfirmed CPSE:\nNCCI bundling guidelines don’t allow E0045 and A4606 to be billed on the same date of service. Per OAC 5160.10.23 it states separate payment may be made for probes. ","2023-04-21","76-Durable Medical Equipment Supplier","2023-05-15","Adjustment Completed 7/7/2023","Completed"]
["Unique ID:273\nConfirmed CPSE:\nClaims with codes listed on the TPL bypass list for member with Commerical Insurance Identified were recouped in error.\n","2023-04-27","95-ODADAS Certified/Licensed (SUD) Treatment Program\r\n84-Ohio Department of Mental Health (Community Mental Health) Provider ","ETA 8/25/2023","Recoveries completed 6/23/2023\nAdjustment ETA 6/22/2023-8/4/2023","Ongoing \nremediation"]
["Unique ID:275\nConfirmed CPSE:\nMolina received a incorrect file from our Credit Balance Vendor requesting offset in error when they meant to send a remit file. Molina is currently reviewing file to create refunds to Providers who claims were recouped in error when they submitted a refund check to Molina. ","2023-05-17","82-Ambulance\r\n01-Hospital (Outpatient)\r\n76-Durable Medical Equipment Supplier\r\n21-Professional Medical Group","2023-07-10","Checks reissued 4/20/2023, 5/9/2023, 5/18/2023, 5/25/2023","Fix is complete"]
["Unique ID:276\nConfirmed CPSE:\nPer AMA CPT Manual, CPT 99418 is a new add-on code for E/M services codes: (99223, 99233, 99236, 99255, 99306, 99310) effective 1/1/2023. CPT 99418 is being denied for inappropriate add-on code. KB Q2A 2023 was loaded on 5/15/2023 stopping incorrect denials. ","2023-05-25","21-Professional Medical Group","2023-05-15","Adjustment Completed 6/22/2023","Completed"]
["Unique ID:277\nConfirmed CPSE:\nEdit 9537/9322 is denying the LARC device when billed correctly by provider and the Inpatient claim contains all required criteria to be paid. CES has advised the logic is no longer working and needs to be updated to their new platform of dynamic.   ","2023-05-12","01-Hospital (Inpatient)","2023-07-03","Adjustment ETA 7/13/2023-8/24/2023","Fix is complete"]
["Unique ID:278\nConfirmed CPSE:\nBH services for provider specialties for QMHS (Bachelors and +3 years) processing incorrectly causing overpayment and underpayments.","2023-06-05","95-ODADAS Certified/Licensed (SUD) Treatment Program\r\n84-Ohio Department of Mental Health (Community Mental Health) Provider \r\n01-Hospital (Outpatient)","2023-06-20","Adjustment ETA 6/28/2023-8/10/2023\nRecoveries Completed 7/12/2023","Fix is complete"]
["Unique ID:279\nNew Potential CPSE:\nOn 12/1/2022 Cotiviti’s CV Edit 6268 DP 11471 was turned on, modification wasn’t made to exclude chiropractors from edit. They should be excluded due to ODM’s guidance and allowing chiropractor’s to bill an E/M with spinal manipulation on the same day with modifier 25 and the NCCI bundle would be bypassed for these services.   ","2023-06-16","27-Chiropractor Individual","ETA 10/14/2023","ETA 12/12/2023","Ongoing \nremediation"]
["Unique ID:280\nNew Confirmed CPSE:\nClaims are incorrectly overriding NCCI edits causing claims to receive Grouper Return Code 61 in error.","2023-06-14","01-Hospital (Outpatient)","2023-06-14","Adjustment ETA 7/11/2023-8/22/2023","Fix is complete"]
["Unique ID:281\nNew Potential CPSE:\nBH claims are incorrectly denying for inconsistent modifier(s) for providers with QMHS Specialties.","2023-06-23","84-Ohio Department of Mental Health (Community Mental Health) Provider ","ETA 10/21/2023","ETA 12/20/2023","Ongoing \nremediation"]
["Unique ID:282\nNew Confirmed CPSE:\nEmergency room claims for non emergent usage were being reimbursed at a higher level of care instead of being downcoded to lower level of care for E and M services per OAC 5160-2-77.","2023-07-13","01-Hospital (Outpatient)","ETA 11/10/2023","ETA 1/9/2024","Ongoing \nremediation"]