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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"]

{"sheet":"CPSE Report Log  ","index":1,"n_rows":19,"n_cols":7,"rows_kept":19,"cut":false,"hidden":false,"merged":[[0,1,0,4],[0,5,0,6],[1,0,1,6]]}
[null,"Molina Healthcare of Ohio \nClaims Payment Systemic Errors ",null,null,null,"July 2024"]
["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: 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","44-Hospice, 86-Nursing Facility","ETA 7/26/2024","ETA 10/19/2024","Ongoing \nremediation"]
["Unique ID: 325\nConfirmed CPSE\nHospital outpatient claims are not paying the contracted rate with Molina for dates of service on and after 1/1/24. ","Medicaid","2024-02-27","01-Hospital (Outpatient)","2024-02-28","\nAdjustment Complete 6/10/2024\nRecovery Complete 6/13/2024","Complete"]
["Unique ID: 330\nConfirmed CPSE\nEdit was denying A4351 in error for billing over the benefit amount of 200 per calendar month. The edit was set up with rolling days and not calendar days. ","Medicaid","2024-03-06","76-Durable Medical Equipment Supplier","2024-04-28","\nAdjustment Complete- 7/2/2024","Complete"]
["Unique ID: 331\nConfirmed CPSE\nEdit denying HPCPS codes H0005 and H0006  in error for exceeding the Medically Unlikely Edits (MUE) of 1 unit per day. ","Medicaid","2024-03-27","84-Ohio Department of Mental Health (Community Mental Health) Provider ","2024-04-22","Adjustment Complete - 7/5/2024","Complete"]
["Unique ID: 332\nConfirmed CPSE\nEdit denying Behavioral health services when billed with modifier GT in error. ","Medicaid","2024-04-04","12-Federally Qualified Health Center, 54-Licensed Independent Chemical Dependency Counselor, 95-ODADAS Certified/Licensed (SUD) Treatment Program, 84-Ohio Department of Mental Health (Community Mental Health) Provider , 42-Psychologist, Individual, 21-Professional Medical Group, 37-Licensed Independent Social Worker (LISW)","2024-05-20","\nAdjustment ETA - 6/6/2024 - 7/19/2024","Fix is complete"]
["Unique ID: 333\nPotential CPSE\nCPT 90671 paying in error because it was not configured as VFC. \nAfter final review, not a CPSE. ","Medicaid","2024-04-08","21-Professional Medical Group","\n4/29/2024 ","After final review, not a CPSE. ","Complete"]
["Unique ID: 336\nPotential CPSE\nNon-payable REV codes are not being excluded during pricing of inpatient DRG hospital claims. ","Medicaid","2024-04-24","01-Hospital (Inpatient)","ETA 10/14/2024","ETA 1/9/2025 ","Ongoing \nremediation"]
["Unique ID: 337\nPotential CPSE\nLTAC rate sheets are set to price on discharge and not admit date. ","Medicaid","2024-04-26","86-Nursing Facility","2024-05-30","ETA 1/13/2025 ","Fix is complete"]
["Unique ID: 338\nPotential CPSE\nCodes M0224 and Q0224 will be configured in Molina’s system after the required 20-day turnaround requirement from the 3M release date of 5/16/2024 for EAPG outpatient hospital and ASC claims only. ","Medicaid","2024-05-07","01-Hospital (Outpatient)","2024-06-11","ETA 1/22/2025","Fix is complete"]
["Unique ID: 339\nConfirmed CPSE\nH0040 is being denied against non BH providers, causing invalid denials.","Medicaid","2024-05-15","00-All provider types","2024-06-03","\nAdjustment ETA 6/24/2024 - 8/6/2024","Fix is complete"]
["Unique ID: 340\nPotential CPSE\nProviders receiving remit for VOID claims in error. ","Medicaid","2024-05-15","00-All provider types","ETA 11/4/2025","ETA 1/31/2025","Ongoing \nremediation"]
["Unique ID: 341\nPotential CPSE\nBehavioral Health rates for codes 99112, 99113, 96130, 96131, 96136 and 96137 were not included when loading the 1/1/24 updates.","Medicaid","2024-06-10","95-ODADAS Certified/Licensed (SUD) Treatment Program, 84-Ohio Department of Mental Health (Community Mental Health) Provider ","ETA 11/27/2024","ETA 2/24/2025 ","Ongoing \nremediation"]
["Unique ID: 342\nNew Potential CPSE\nNeuropsychological and Psychological Testing CPT codes: 96112, 96113, 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137 were incorrectly configured for requiring prior authorization on or after claim date of service 1/1/2024.","Medicaid","2024-06-19","12-Federally Qualified Health Center, 01-Hospital (Outpatient), 21-Professional Medical Group, 02-Psychiatric Hospital","ETA 12/6/2024","ETA 3/5/2025","Ongoing \nremediation"]
["Unique ID: 343\nNew Potential CPSE\nCustom edit for Incontinence supplies (T4521-T4538) did not get updated with 2024 allowances. ","Medicaid","2024-06-26","76-Durable Medical Equipment Supplier","ETA 12/13/2024","ETA 3/12/2025","Ongoing \nremediation"]
["Unique ID: 344\nNew Potential CPSE\nCPT 99241-99243 have been denying incorrectly when GT Modifier is used. ","Medicaid","2024-06-27","76-Durable Medical Equipment Supplier","ETA 12/16/2024","ETA 3/13/2025","Ongoing \nremediation"]
["Unique ID: 345\nNew Potential CPSE\nPresumptive and Definitive testing billing guidelines were updated for CPT 80305, 80306, 80307, G0481 and G0482 but Payment Integrity's review concept information was outdated, causing claims to be recovered in error. ","Medicaid & MyCare","2024-07-08","01-Hospital (Outpatient), 80-Independent Laboratory, 21-Professional Medical Group","2024-07-08","ETA 3/24/2025","Fix is complete"]