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Claims update
In the financial week ending May 26, the Department processed 792,858 submitted claims and paid $111,025,202, or 60 percent of all claims processed. Based on historic trends under the old system, we would expect about 85 percent of all claims submitted to be paid. That remains our goal for the new system, as well, and we are continuing to push toward that goal. The Department has never paid 100 percent of all claims due to a variety of factors from errors in submissions to requests for reimbursement for non-covered services.
Clinic co-pays
Currently co-pays on claims billed by clinic providers are not being deducted. This is a known issue, and the Department will provide further guidance on how the inappropriately billed co-pays will be resolved soon.
Valid CLIA licenses
Some claims submitted with valid CLIA licenses are incorrectly denying in the system. While a system fix was implemented for the issue, providers continue to report this issue. Efforts to solve this are underway and are estimated to be completed in early June. Claims impacted by this issue will be reprocessed when the issue is resolved.
Manual pricing and no-cost pricing
Some issues around manual pricing - including attempts to add zero cost - continue. For example, claims for the procedure code covering the Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use continue to deny. For this issue, a system change is being implemented and claims will be reprocessed when the issue is resolved. Additional issues around submitting a service detail line with a zero dollar amount for children continue. Our vendor is working on the issue's resolution.
Intermittent Portal Error
Some providers have reported intermittent portal errors when attempting to access their accounts. The Department is aware of this problem and the vendor is working to isolate and resolve the issue. While no single work around has been discovered while a permanent fix is developed, some providers have had success by trying the following:
- Clear your browser's cache
- Reboot your computer
- Retry accessing the portal
Mass adjusted claims
The mass adjustment is prompted by either an overpayment or prepayment. Each claim will be listed on your remittance advice report under "Accounts Receivable".
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