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["\n\n\n\n\n","Molina Healthcare of Ohio \nClaims Payment Systemic Errors ",null,null,null,"March 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)","ETA 3/31/2023","Workaround started 6/8/2022\nETA 3/31/2023","Ongoing \nremediation"]
["Unique ID:247\nConfirmed CPSE:\nOptum advised The 10/1/2022 Provider-Administered Pharmaceutical fee schedule updates will be completed beyond ODM's 25 calendar day requirement. ","2022-10-24","01-Hospital (IP & OP)","2022-11-10","Batch 1 Adjustment Completed 2/27/2023 \nBatch 2 Adjustment Completed  3/9/2023\nBatch 3 Adjustment Completed 3/8/2023\nRecoveries Completed 2/27/2023","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 ETA 3/3/2023-4/14/2023\nBatch 4 Adjustment ETA 3/3/2023-4/14/2023","Fix is complete"]
["Unique ID:252\nConfirmed CPSE:\nAfter an Optum release version on non-behavioral health claims or non COVID-19 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 ETA 2/7/2023-3/21/2023","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 1/1/2023. 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 ETA 2/21/2023- 4/4/2023 ","Fix is complete"]
["Unique ID:255\nPotential CPSE:\nA potential claims issue has been identified resulting in both over and under payments. Claims are either denying in error for prior authorization when one is not required or an authorization was required however it was not properly reflected on Molina's website.\nAfter Final Review, Not a CPSE.","2023-02-07","00-All provider types","2023-03-10","After Final Review, Not a CPSE.","Complete"]
["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:257\nPotential CPSE:\nA potential claims issue has been identified for Outpatient BH Hospital claims where claims are incorrectly denying when there is a valid Outpatient BH Services Diagnosis present on the claim\nAfter Final Review, Not a CPSE.","2023-02-07","01-Hospital (Outpatient)","2023-03-10","After Final Review, Not a CPSE.","Complete"]
["Unique ID:258\nPotential  CPSE:\nClaims paid in error due to providers choosing the incorect payerid  through the Change Healthcare claims submission process.\nAfter Final Review, Not a CPSE.","2023-02-10","00-All provider types","2023-02-20","After Final Review, Not a CPSE.","Complete"]
["Unique ID:259\nNew Confirmed 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","ETA 6/13/2023","ETA 8/12/2023","Ongoing \nremediation"]
["Unique ID:260\nNew Confirmed CPSE:\nMCPF Solution went live causing MMP Medicare claims to deny in error which impacted MMP Medicaid claims.","2023-02-21","00-All provider types","2023-02-23","Batch 1 Adjustment ETA 3/1/2023-4/12/2023\nBatch 2 Adjustment ETA 3/14/2023-4/25/2023","Fix is complete"]
["Unique ID:261\nNew Potential 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","Ongoing \nremediation"]
["Unique ID:262\nNew Confirmed CPSE:\nDental Claim denials for D9230 due to delays in communicating updates to covered services.","2023-03-01","30-Dentist, Individual","2023-03-01","Adjustment Completed 3/8/2023","Complete"]
["Unique ID:263\nNew Potential 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","ETA 7/1/2023","ETA 8/30/2023","Ongoing \nremediation"]
["Unique ID:264\nNew Confirmed CPSE:\nClaims denied for benefit limit exceeded in error due to incorrect configuration loaded for benefit accumulation. ","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","ETA 7/31/2023","Ongoing \nremediation"]