{"text_format":"1","workbook":"xlsx","n_sheets":1,"sheets":["Online Report Template"],"not_rendered":{"charts":0,"images":1,"macros":1,"external_links":0,"defined_names":2,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Online Report Template","index":0,"n_rows":21,"n_cols":6,"rows_kept":21,"cut":false,"hidden":false,"merged":[[0,1,0,4],[1,0,1,5]]}
["\n\n\n\n\n","Molina Healthcare of Ohio \nClaims Payment Systemic Errors ",null,null,null,"June 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","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:252\nConfirmed CPSE:\nAfter an Optum release version on non-behavioral health claims or non COVID-19 related claims, billed with vaccine and/or vaccine administration codes were incorrectly set to price only with modifier HE.","2022-12-06","01-Hospital (Outpatient)","2022-12-08","Adjustment Batch 1 Completed 3/16/2023\nRecoveries Completed 3/22/2023 \nAdjustment Batch 2 Completed  6/1/2023","Completed"]
["Unique ID:256\nConfirmed CPSE:\nCorrecting claims payment to align to the retroactive rate change ODM sent for EAPG and OPHBH Monkey Pox Updates.","2023-01-18","01-Hospital (Outpatient)","2023-01-18","Adjustment Batch 1 completed 3/1/2023\nAdjustment Batch 2 completed  5/24/2023\n","Completed"]
["Unique ID:261\nConfirmed CPSE:\nThe Central Medicare Unit (CMU) closed submitted authorization requests stating no authorization is required for services for the first three 30-days, this only applies for Medicare billed services. This caused the Medicaid billed services to deny in error. Codes G0151, G0152, G0153, G0156, G0299, G0300 and T1000.","2023-02-27","16 & 60-Home Health Agency","ETA 6/27/2023\nPartial Fix G0156  2/28/2023","Workaround started for G0156 2/28/2023\nETA 8/26/2023\nAdjustment (G0156) completed 6/1/2023\n","Ongoing \nremediation"]
["Unique ID:263\nConfirmed CPSE:\nPaper Claims that were received and submitted to Change Health Care, the clearing house is changing the Insured and Subscriber information causing Molina claim to reject for Member Not Found in error.","2023-01-24","00-All provider types","2023-04-04","Reprocessing Claims Completed 5/5/2023, 5/8/2023, 5/10/2023, 5/12/2023, 5/15/2023-5/17/2023, 5/19/2023, 5/22/2023-5/24/2023, 5/31/2023","Completed"]
["Unique ID:266\nConfirmed CPSE:\nCPT codes G0316, G0317 and G0318 are denying in error hitting Edit 9521 (ONLY ONE EVALUATION AND MANAGEMENT CODE AT THIS SERVICE LEVEL IS COVERED DURING THE COURSE OF CARE).","2023-03-21","21-Professional Medical Group","Partial Fix G0316 4/10/2023\nOverall Fix 5/15/2023","Adjustment Batch 1 Completed  5/25/2023\nAdjustment Batch 2 Completed  5/26/2023","Completed"]
["Unique ID:267\nConfirmed CPSE:\nClaims are denying in error for PA when billed with Place of Service 31, 32 and 33 for Non-Par Providers.","2023-03-23","00-All provider types","2023-04-21","Adjustment Batch 1 Completed  5/12/2023\nAdjustment Batch 2 Completed 6/13/2023","Completed"]
["Unique ID:268\nPotential CPSE:\nThe National Physician Fee Schedule (NPFS) updated the PC/TC indicator for dental codes from \"9\" to \"5\" effective 1/1/2023. Indicator 5 allows facilities to bill dental codes. CES incorrectly started to deny ASC facility claims reported on HCFA 1500 forms in error. Modification has been submitted to exclude ASC facility specialties to allow for correct reimbursement.\nAfter Final Review, NOT a CPSE","2023-04-04","46-Ambulatory Surgery Center","2023-05-15","After Final Review, NOT a CPSE","Completed"]
["Unique ID:269\nPotential CPSE:\nNew Marketplace fee schedule allowed payments for BH codes listed on the TPL bypass list to process for payment. Due to the new fee schedule and the configuration to allow those payments, claims that should pay as primary for 84/95 providers stopped paying as primary and only processed under the Medicaid line of business if Marketplace allowed patient responsibility resulting in the provider being underpaid.  ","2023-04-17","84-Ohio Department of Mental Health (Community Mental Health) Provider \r\n95-ODADAS Certified/Licensed (SUD) Treatment Program","ETA 8/15/2023","Workaround started 4/24/2023\nETA 10/14/2023","Ongoing \nremediation"]
["Unique ID:270\nConfirmed CPSE:\nIT deployment on 4/11/2023 corrupted ruleset/post validations for UB04 claims causing bill type not to load.","2023-04-13","01-Hospital (IP & OP)","2023-04-20","ETA 10/11/2023","Fix is complete"]
["Unique ID:271\nConfirmed CPSE:\nNCCI bundling guidelines don’t allow E0045 and A4606 to be billed on the same date of service. Per OAC 5160.10.23 it states separate payment may be made for probes. ","2023-04-21","76-Durable Medical Equipment Supplier","2023-05-15","Adjustment ETA 6/1/2023-7/14/2023","Fix is complete"]
["Unique ID:272\nConfirmed CPSE:\nA4259 was configured as a non covered code in error. Per ODM should be covered eff 1/1/23.","2023-04-13","76-Durable Medical Equipment Supplier","2023-04-14","Adjustment Batch 1 Completed  5/31/2023\nAdjustment Batch 2 Completed 5/19/2023","Completed"]
["Unique ID:273\nConfirmed CPSE:\nClaims with codes listed on the TPL bypass list for member with Commerical Insurance Identified were recouped in error\n","2023-04-27","95-ODADAS Certified/Licensed (SUD) Treatment Program\r\n84-Ohio Department of Mental Health (Community Mental Health) Provider ","ETA 8/25/2023","ETA 10/24/2023","Ongoing \nremediation"]
["Unique ID:274\nNew Confirmed CPSE:\nClaims that should have been partially paid or partially denied by our Vendor March Vision were instead fully denied in error.\n","2023-05-15","35-Optometrist Individual","2023-05-10","Adjustment completed -5/10/2023","Completed"]
["Unique ID:275\nNew Confirmed CPSE:\nMolina received a incorrect file from our Credit Balance Vendor requesting offset in error when they meant to send a remit file. Molina is currently reviewing file to create refunds to Providers who claims were recouped in error when they submitted a refund check to Molina. ","2023-05-17","82-Ambulance\r\n01-Hospital (Outpatient)\r\n76-Durable Medical Equipment Supplier\r\n21-Professional Medical Group","ETA 9/14/2023","ETA 11/12/2023","Ongoing \nremediation"]
["Unique ID:276\nNew Confirmed CPSE:\nPer AMA CPT Manual, CPT 99418 is a new add-on code for E/M services codes: (99223, 99233, 99236, 99255, 99306, 99310) effective 1/1/2023. CPT 99418 is being denied for inappropriate add-on code. KB Q2A 2023 was loaded on 5/15/2023 stopping incorrect denials. ","2023-05-25","21-Professional Medical Group","2023-05-15","Adjustment ETA 5/31/2023-7/12/2023","Fix is complete"]
["Unique ID:277\nNew Potential CPSE:\nEdit 9537/9322 is denying the LARC device when billed correctly by provider and the Inpatient claim contains all required criteria to be paid. CES has advised the logic is no longer working and needs to be updated to their new platform of dynamic.   ","2023-05-12","01-Hospital (Inpatient)","ETA 9/9/2023","ETA 11/7/2023","Ongoing \nremediation"]
["Unique ID:278\nNew Potential CPSE:\nBH services for provider specialties for QMHS (Bachelors and +3 years) processing incorrectly causing overpayment and underpayments.","2023-06-05","95-ODADAS Certified/Licensed (SUD) Treatment Program\r\n84-Ohio Department of Mental Health (Community Mental Health) Provider \r\n01-Hospital (Outpatient)","ETA 10/3/2023","ETA 12/1/2023","Ongoing \nremediation"]
[null,null,null,null,null,"MHO-PROV-0032"]