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["MCE Online CPSE Report Guidelines"]
["Each time a CPSE report is updated, the previous month's report is to remain available, at a minimum."]
["The date the report was posted is to be clearly visible at the top of the report."]
["Contact information should be clearly listed on each report for providers to utilize if they have questions."]
["If the MCE posts the online CPSE report to their provider portal where log-in access is required, a direct link to the online CPSE report is to be provided with the ODM report submission each month."]
["Template Column Header","Template Column Instructions"]
["Column A: Unique ID and Description of CPSE","• Each CPSE is to be given a unique identifier, stated at the beginning of the description.\n• In this column, a clear and complete description of the CPSE is required. The description needs to include specifically what is being impacted (e.g. procedure codes, modifiers, places of service, etc.). The description needs to be understandable at a high level to individuals outside of the MCE and should not include acronyms or MCE specific language.\n• Each CPSE needs to be labeled as a potential or confirmed CPSE. Once a potential CPSE is confirmed, the description needs updated. \n• If any previously reported CPSE is later found to not be a CPSE, the description needs updated to add a statement reporting that the issue was found to not be a CPSE. The issue may then be removed from the next report."]
["Column B: Line of Business","• In this column, the line of business that the CPSE impacts should be selected. This only applies to MCEs that have both Medicaid and MyCare lines of business.\n• If a CPSE impacts both Medicaid and MyCare lines of business, you should select \"Medicaid & MyCare\"."]
["Column C: Date CPSE was First Identified","• In this column, the date the CPSE was first identified by the MCE and/or their contracted vendor is required. If the MCE was notified by their vendor on a date after the vendor identified the CPSE, the date the vendor identified the CPSE should be listed rather than the date the MCE was notified. "]
["Column D: Billing Provider Type(s) Impacted by CPSE (select all that apply)","• This column should include all billing provider types impacted by the CPSE. This information should be updated as needed if it changes.\n• This column refers to the billing provider, not the rendering provider.\n• Provider type \"00-All Provider Types\" is to be used sparingly and only when all provider types on the list could be and/or already are impacted by the CPSE.\n• There is a list of billing provider types on the \"CPSE Provider Types\" tab for reference that matches the drop down list on the template. If there is a provider type believed to be missing from the template, update the description in column A to include that provider type and notify ODM."]
["Column E: Timeline for Fixing CPSE","• This column should include the date(s) the system was fixed. An estimated date may be used until an exact date is known. This should be updated as needed. "]
["Column F: Date(s) and/or Date Span(s) of Corrected Claims Adjustments","• In this column, the individual date(s) and/or date span(s) for any corrected claims adjudication is required. This includes system and manual adjustments. An estimated date may be used until an actual date is known.\n• If a date span lasts over 30 days, a brief explanation as to the cause of the length is needed.\n• If the plan choses to not complete claim adjustments, that needs to be stated in this column.\n• If the plan has to process recoupments due to overpayments, that needs indicated in this column."]
["Column G: CPSE Status","• This column should report the status of each CPSE (e.g. ongoing, in progress, fix is complete, completed, etc.) and updated when it changes."]

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["ODM Provider Types","23-Acupuncturist"]
[null,"82-Ambulance"]
[null,"46-Ambulatory Surgery Center"]
[null,"68-Anesthesia Assistant, Individual"]
[null,"74-Assisted Living Facilities"]
[null,"43-Audiologist, Individual"]
[null,"53-Behavior Analyst"]
[null,"73-Certified Registered Nurse Anesthetist (CRNA), Individual"]
[null,"27-Chiropractor, Individual"]
[null,"50-Clinic"]
[null,"65-Clinical Nurse Specialist, Individual"]
[null,"30-Dentist, Individual"]
[null,"07-Dietitian"]
[null,"76-Durable Medical Equipment Supplier"]
[null,"59-End-Stage Renal Disease (Dialysis) Clinic"]
[null,"12-Federally Qualified Health Center"]
[null,"11-Free Standing Birth Center"]
[null,"16 & 60-Home Health Agency"]
[null,"44-Hospice"]
[null,"01-Hospital (Inpatient)"]
[null,"01-Hospital (Outpatient)"]
[null,"01-Hospital (IP & OP)"]
[null,"79-Independent Diagnostic Testing Facility"]
[null,"80-Independent Laboratory"]
[null,"52-Independent Marriage and Family Therapist"]
[null,"54-Licensed Independent Chemical Dependency Counselor"]
[null,"37-Licensed Independent Social Worker (LISW)"]
[null,"51-Mental Health Clinic"]
[null,"26-Non-Agency Home Care Attendant"]
[null,"25-Non-Agency Personal Care Aide"]
[null,"89-Non-State Operated ICF-IID"]
[null,"71-Nurse Midwife Individual"]
[null,"72-Nurse Practitioner, Individual"]
[null,"86-Nursing Facility"]
[null,"41-Occupational Therapist, Individual"]
[null,"95-ODADAS Certified/Licensed (SUD) Treatment Program"]
[null,"84-Ohio Department of Mental Health (Community Mental Health) Provider "]
[null,"15-Optical Laboratories"]
[null,"75-Optician"]
[null,"35-Optometrist, Individual"]
[null,"04-Outpatient Health Facility"]
[null,"96-Paraprofessional"]
[null,"69-Pharmacist, Individual"]
[null,"70-Pharmacy"]
[null,"39-Physical Therapist, Individual"]
[null,"24-Physician Assistant"]
[null,"20-Physician/Osteopath, Individual"]
[null,"36-Podiatrist, Individual "]
[null,"81-Portable X-Ray Supplier"]
[null,"38-Private Duty Non-Agency RN or LPN"]
[null,"47-Professional Clinical Counselor"]
[null,"31-Professional Dental Group"]
[null,"21-Professional Medical Group"]
[null,"02-Psychiatric Hospital"]
[null,"03-Psychiatric Residential Treatment Facility (PRTF)"]
[null,"42-Psychologist, Individual"]
[null,"05-Rural Health Clinic"]
[null,"40-Speech Language Pathologist, Individual"]
[null,"88-State Operated ICF-IID"]
[null,"55-Waivered Services, Individual "]
[null,"45-Waivered Services Organization"]
[null,"83-Wheelchair Van"]
[null,"00-All provider types"]
[]
[]
["Line of Business","Medicaid"]
[null,"MyCare"]
[null,"Medicaid & MyCare"]

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[null,"Molina Healthcare of Ohio \nClaims Payment Systemic Errors ",null,null,null,"December 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","Line of Business","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:282\nConfirmed 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","Medicaid & MyCare","2023-07-13","01-Hospital (Outpatient)","2023-08-15","\nAdjustment Batch 1 ETA Completed 12/11/2023 \nAdjustment Batch 2 ETA 11/14/2023-12/28/2023\n","Fix is complete"]
["Unique ID:284\nConfirmed CPSE:\nProviders that submit claims with attachments through Availity, the submission is either completely missing the attachment or the attachment is being delayed causing some claims to deny.","Medicaid & MyCare","2023-07-19","01-Hospital (Outpatient), 01-Hospital (Inpatient)","2023-08-08","\nAdjustment Batch 1 Completed 09/12/2023\nAdjustment Batch 2 completed 11/28/2023","Complete"]
["Unique ID:285\nConfirmed CPSE:\nBH providers with specialty listed of Nurse Practitioner claims are denying for Ordering Provider in error.","Medicaid & MyCare","2023-07-28","84-Ohio Department of Mental Health (Community Mental Health) Provider ","2023-09-25","\n\nBatch 1 Adjustment ETA 11/08/2023 - 12/20/2023\nBatch 2 Adjustment completed 11/10/2023","Fix is complete"]
["Unique ID:286\nConfirmed l CPSE:\nMolina’s claim loader experienced intermittent slowness which causes incomplete loads in the pre-adjudication database.","Medicaid & MyCare","2023-08-02","21-Professional Medical Group\r\n95-ODADAS Certified/Licensed (SUD) Treatment Program","ETA 01/26/2024","ETA 04/22/2024\nWorkaround started 08/18/2023","Ongoing \nremediation"]
["Unique ID:289\nConfirmed CPSE:\nInpatient and outpatient claims with DOS that span before and after 07/28/23 are pricing incorrectly.\n","Medicaid & MyCare","2023-08-09","01-Hospital (Inpatient)","2023-09-05","\nAdjustment batch 1 completed 09/19/2023\nAdjustment batch 2 completed 09/07/2023\nAdjustment batch 3 and 4 completed 08/25/2023\nAdjustment batch 5 ETA 02/05/2024\nRecovery Batch completed 11/23/2023","Fix is complete"]
["Unique ID:290\nConfirmed CPSE:\nOptum has identified an issue with the Medicaid APG Pro Pricer when multiple significant procedure discounting is being erroneously applied to claims lines that should receive full payment.","Medicaid & MyCare","2023-08-10","01-Hospital (IP & OP)","2023-08-22","Adjustment ETA 12/01/2023 - 01/17/2024 ","Fix is complete"]
["Unique ID:294\nPotential CPSE:\nOutpatient hospital claims for the provider Bon Secours Mercy/Mercy Health Partners of SW OH have paid at the incorrect rate. This issue may have potentially impacted the Medicaid claim when coordination of benefits was applied.     \n","Medicaid & MyCare","2023-08-21","01-Hospital (Outpatient)","ETA 02/14/2024","ETA 05/09/2024","Ongoing \nremediation"]
["Unique ID:298\nConfirmed CPSE:\nHearing services paid incorrectly under the fee for services professional contracts.","Medicaid & MyCare","2023-09-26","76-Durable Medical Equipment Supplier","2023-12-04","ETA 06/14/2024","Fix is complete"]
["Unique ID:299\nConfirmed CPSE:\nMolina is incorrectly applying Patient Liability to claims when the member has a patient liability type is waiver or pro-rated waiver  ","Medicaid & MyCare","2023-10-04","86-Nursing Facility","ETA 03/29/2024","ETA 06/25/2024","Ongoing \nremediation"]
["Unique ID:301\nConfirmed CPSE:\nClaims incorrectly rejected for “Member Not Found” error. Claim routing process between Molina HPs and lines of business failed to recognize the member billed on the claim as a Molina OH claim because a key table used to look up the member information failed to update on different dates in 2023. ","Medicaid & MyCare","2023-09-01","00-All provider types","ETA 02/28/2024","ETA 05/22/2024","Ongoing \nremediation"]
["Unique ID:302\nPotential CPSE:\nOhio Medicaid outpatient claims are denying revenue code 250 lines for missing/incomplete/invalid procedure code. Per the Ohio Medicaid Hospital billing guidelines manual, no HCPCS is required for Ohio Medicaid claims when billed as outpatient.  ","Medicaid","2023-10-13","01-Hospital (Outpatient)","ETA 04/08/2024","ETA 07/03/2024","Ongoing \nremediation"]
["Unique ID:304\nPotential CPSE:\nWaiver claims are linking to incorrect authorizations. This is causing the authorized provider to have claims deny for units being exhausted prematurely. It is also allowing the other providers to be paid without confirmation there is an authorization on file for them.","Medicaid & MyCare","2023-11-09","00-All provider types","ETA 05/03/2024","ETA 07/31/2024","Ongoing \nremediation"]
["Unique ID:305\nPotential CPSE:\nBehavioral health claims are denying incorrectly as a duplicate when the same service is rendered to the same patient by the same practictioner on the same date of service when something else differs such as place of service or modifier. ","Medicaid","2023-10-30","84-Ohio Department of Mental Health (Community Mental Health) Provider ","ETA 04/23/2024","ETA 07/19/2024","Ongoing \nremediation"]
["Unique ID:306\nNew Potential CPSE:\nOptum has identified an issue with the capital Disproportionate Share (DSH) factor for hospitals located in an urban area that were reclassified as rural with 100 or more beds. Capital DSH payments are only made to urban hospitals with 100 or more beds. Previously, when a hospital was reclassified from urban to rural, it was not eligible for capital DSH payments. Per the FY 2024 IPPS Final Rule, for discharges occurring on or after October 01, 2023, hospitals with 100 or more beds in urban areas that are reclassified as rural are now eligible for capital DSH payments. This update was inadvertently not implemented.","Medicaid","2023-11-15","01-Hospital (Inpatient)","2023-11-09","ETA 07/24/2024","Fix is complete"]
["Unique ID: 307                                                                                                                          \nNew Potiential CPSE                                                                                                                     \nER Claim lines/claims denying for no PA. ER Services should process without 205 or 367 firing","Medicaid ","2023-11-27","00-All provider types ","ETA 05/17/2023 ","ETA 08/14/2024","Ongoing \nremediation"]
["Unique ID: 308                                                                                                                           \nNew Potential CPSE                                                                                                                    \nThe updated 10/1/2023 EAPG Covered Code List that added 37 procedure codes and end-dated 20 procedure codes and the Outpatient Behavioral Health Fee Schedule changes that added 6 new COVID-19 codes will be configured in Molina’s system after the required 20-day turnaround requirement from the 3M release date of 11/16/23.   ","Medicaid ","2023-11-22","00-All provider types ","2023-12-12","ETA 08/02/2024 ","Fix is complete"]
["Unique ID: 309                                                                                                                          \nNew Potential CPSE                                                                                                                    \nFor outpatient facility claims only, the COVID and RSV code changes on the provider-administered pharmaceutical fee schedule received 11/13/2023 will be updated in Molina’s system beyond the 20-day turnaround requirement. ","Medicaid ","2023-11-22","01-Hospital (Outpatient)","2023-12-12","ETA 08/02/2024 ","Fix is complete"]
["Unique ID: 310                                                                                                                        \nNew Potential CPSE                                                                                                                   \nCMS updates to POA reporting on 09/30/2023 but the Molina system was not updated at the time. This is causing claim denials on claims with diagnosis codes Z62.29,  Z62.810, Z62,812 and Z62.819. An update request has been submitted. ","Medicaid ","2023-12-11","01-Hospital (Inpatient)","ETA 06/03/2024 ","ETA 08/28/2024 ","Ongoing \nremediation"]
["Unique ID: 311                                                                                                                         \nNew Potential CPSE                                                                                                                   \nIncorrect calculation for IP claims that contain diagnosis code U07.1 and either procedure code XW033E5 or XW043E5 that are also eligible for the new technologies add-on payment on the same claim.","Medicaid","2023-12-12","01-Hospital (Inpatient)","ETA 05/06/2024","ETA 08/01/2024","Ongoing \nremediation"]