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Claims Update
In the financial week ending May 26, the Department processed 689,481 submitted claims and paid $115,555,598 or 61 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.
Since the new system launched on March 1, we have processed nearly 11 million claims and paid providers more than $1.5 billion.
Missing Affiliations Do Not Cause Claim Denials
Providers have questions about claims with EOB code 3110 for "the rendering provider is not a group member". While it may be unclear on the remittance advice, notations that affiliations are missing do not cause the claim to deny and are informational only. Currently, the Department is giving providers an extended grace period to make all necessary updates to their affiliations to avoid future claims denials. If EOB code 3110 appears on a claim, providers should check their affiliations and make sure they are up to date, and check other EOB codes to see why the claim denied. Updated affiliations are currently taking at least three weeks for final approval. Providers should not submit duplicate update requests.
Remittance Advice Quick Guides
An important change in the new system is the way remittance advice (RA) is reported. These changes can directly impact the ability of providers to understand the claims system, as well as create barriers to resolving problems. To help providers learn about the new remittance advice, the Department has published
an easy-to-use, line-by-line Remittance Advice Quick Guide
to reading Remittance Advices. Additionally, providers are reporting confusion around the way the Remittance Advice is downloading and printing. For instructions on pulling and formatting your remittance advice
refer to this Quick Guide
.
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 workaround has been discovered while a permanent fix is developed, some providers have had success by trying the following:
- Clear your browser's cache.
- Log out and come back at a later time - even a few minutes may help.
- Use the system during non-peak hours, which are Monday through Friday before 9 a.m. or after 4 p.m. or anytime during Saturday or Sunday.
- Try using another browser. Internet Explorer is recommended.
Newborn Male-only Services
Providers are reporting that the system denies claims for newborn services provided to male infants when those claims are filed under the mother's Medicaid ID. The issue arises due to the gender difference and the system's rejection of certain procedures not available for females. For example, a female would not have a circumcision. This system error affects claims where the gender-specific service is identified by either procedure or diagnosis codes. If the mother and baby are together in the hospital, providers should continue to submit claims under the mother's Medicaid ID. Once either the mother and/or baby is discharged, the baby's Medicaid ID should be used. At this time, the "services to other than client" UK modifier cannot be used to identify that the claim is for the baby and not the mother. The issue is being worked on, but no final fix date has been identified.
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