A claims processing error by Indiana Medicaid resulted in as many as thousands of incorrect denials, including claims for at least two anesthesia services. Indiana Health Coverage Programs (IHCP) says they now have the problem fixed, and claims denied inappropriately will be mass reprocessed or mass adjusted, as appropriate.
According to IHCP, the problem resulted from some valid add-on codes, like 96131, 96133, 96137, and 96139, and codes in the alpha-numeric range 0071U-0076U, being denied even when billed correctly. However, the processing error also affected some stand-alone codes, including some category III codes ending in the letter T and some anesthesia codes, which were incorrectly denied as add-on codes. In both cases, the improper denials were reflected on EOBs with denial code 6390 – “Add-on codes are performed in addition to the primary service or procedure and must never be reported as a stand-alone code.”
CIPROMS first noticed the improper denials for anesthesia codes 00731 and 00732. This particular issue affected claims dating back to April 2018 and continuing through August 2019. Denials have exceeded 400 for CIPROMS anesthesiology clients alone. CIPROMS has been working with Indiana Medicaid over the past several months to get the issue addressed, and the resolution was finally announced in an August 13, 2019, IHCP banner page.
Providers should see the reprocessed or adjusted claims on Remittance Advices (RAs) beginning September 11, 2019, with internal control numbers (ICNs)/Claim IDs that begin with 80 (reprocessed denied claims) or 52 (mass replacement non-check related). For claims that were underpaid, the net difference will be paid and reflected on the RAs.
For more information, review IHCP banner page BR201933.
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