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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":25,"n_cols":7,"rows_kept":25,"cut":false,"hidden":false,"merged":[[0,1,0,4],[0,5,0,6],[1,0,1,6]]}
[null,"Molina Healthcare of Ohio, Inc. \nClaims Payment Systemic Errors ",null,null,null,"May 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 6/26/2024","ETA 9/19/2024","Ongoing \nremediation"]
["Unique ID: 304\nConfirmed 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","55-Waivered Services, Individual , 45-Waivered Services Organization","2024-03-11","\nWorkaround Started 12/26/2023\nAdjustment 3 Completed - 5/13/2024\nAdjustment 2 ETA - 5/7/2024 -  6/19/2024\nAdjustment 1 ETA- 5/10/2024 - 6/24/2024","Fix is complete"]
["Unique ID: 305\nConfirmed CPSE:\nBehavioral health claims are denying incorrectly as a duplicate when the same service is rendered to the same patient by the same practitioner 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 ","2024-01-28","2024-04-15","Complete"]
["Unique ID: 313 \nConfirmed CPSE\nMolina policy is to allow E/M visits to bill immunizations without the requirement of a modifier, claims are denying for modifier not being appended.","Medicaid","2023-12-22","01-Hospital (Outpatient)","2024-04-01","5/1/2024 \n","Complete"]
["Unique ID: 314\nConfirmed CPSE\nClaims for sleep study codes 95782, 95783, 95800, 95801, 95803 and 95806 incorrectly denied for prior authorization as they are not on Molina’s prior authorization list.","Medicaid & MyCare","2024-01-17","01-Hospital (Outpatient), 21-Professional Medical Group","2024-02-02","2024-04-19","Complete"]
["Unique ID: 316\nConfirmed CPSE\nWhen the Med Policy configuration for CPT 90671 was updated as part of the July 2023 PAP Fee Schedule it was updated as non-covered under age 19 in error, causing claims to deny. ","Medicaid","2024-02-05","12-Federally Qualified Health Center, 21-Professional Medical Group","2024-02-16","2024-04-15","Complete"]
["Unique ID: 319\nPotential CPSE\nThe October 1, 2023 Radiopharmaceutical and Contrast Agent APC offset amounts were inadvertently used instead of the January 1, 2024 offset amounts. As a result, any Medicare outpatient claim assigned to the following APC's (5054-5055, 5571-5573, 5591-5594 and 5722) are being paid incorrectly.\nAfter final review, not a CPSE. \n\n","MyCare","2024-02-12","01-Hospital (Outpatient)","2024-02-15","After final review, not a CPSE. ","Complete"]
["Unique ID: 320\nPotential CPSE\nMolina has identified an issue with the Costs per Discharge rates for Medicare Dependent Hospitals (MDHs) and Sole Community Hospitals (SCHs). MDH/SCH claims are being reimbursed incorrectly when the operating hospital-specific rate is greater than the comparable operating federal-specific payment amount.\n\n","MyCare","2024-02-12","01-Hospital (Inpatient)","2024-02-15","ETA 10/24/2024 ","Fix is complete"]
["Unique ID: 322\nConfirmed CPSE\nE/M codes billed in conjunction with an acupuncture service rendered by the same provider to the same individual on the same day have paid in error, when performed by an Acupuncturist. \n\n","Medicaid & MyCare","2024-02-15","23-Acupuncturist","2024-04-28","\nRecovery ETA -  5/8/2024 - 6/20/2024","Fix is complete"]
["Unique ID: 324\nConfirmed CPSE\nClaims for HCBS waiver services are being denied inappropriately for modifiers. \n  \n\n","MyCare","2024-02-27","55-Waivered Services, Individual , 45-Waivered Services Organization","2024-02-27","Adjustment ETA -  5/2/2024 - 7/29/2024","Fix is complete"]
["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 ETA - 5/7/2024 - 6/19/2024\nRecovery ETA - 5/10/2024 - 6/24/2024","Fix is complete"]
["Unique ID: 327\nPotential CPSE\nThe benefit for CPT code 99078 with modifier TH (group pregnancy education) is limiting to 6 sessions per pregnancy instead of 10. \nAfter final review, not a CPSE. \n\n","Medicaid","\n2/23/2024","21-Professional Medical Group","2024-05-06","After final review, not a CPSE. ","Complete"]
["Unique ID: 328\nConfirmed CPSE\nMolina has identified an issue with CPT codes Q4107, Q4236 and Q4253 are denying incorrectly for an NDC number.  ","Medicaid & MyCare","2024-02-28","01-Hospital (Outpatient), 21-Professional Medical Group","2024-03-08","\nAdjustment Medicaid Completed - 5/2/2024\nAdjustment MMP ETA - 5/2/2024 - 6/14/2024\n","Fix is complete"]
["Unique ID: 330\nPotential 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","ETA 11/18/2024","Fix is complete"]
["Unique ID: 331\nPotential 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","\nAdjustment ETA - 5/8/2024 - 6/20/2024","Fix is complete"]
["Unique ID: 332\nConfirmed CPSE\nEdit denying Behavioral Health services when billed with modifier GT in error. ","Medicaid","2024-04-04","00-All provider types","ETA 9/24/2024 ","ETA 12/18/2024","Ongoing \nremediation"]
["Unique ID: 333\nConfirmed CPSE\nCPT 90671 paying in error because it was not configured as VFC. ","Medicaid","2024-04-08","21-Professional Medical Group","\n4/29/2024 ","ETA 12/23/2024","Fix is complete"]
["Unique ID: 334\nConfirmed CPSE\nClaims for OhioRISE members have paid and/or redirected in error causing over and under payments. ","Medicaid","2024-03-18","95-ODADAS Certified/Licensed (SUD) Treatment Program, 84-Ohio Department of Mental Health (Community Mental Health) Provider ","2024-04-29","\nAdjustment ETA - 5/10/2024 - 6/24/2024\nRecovery ETA - 5/10/2024- 6/24/2024","Fix is complete"]
["Unique ID: 335\nPotential CPSE\nOptum has identified an issue with the surgical hierarchy for MDC 04 (Diseases and Disorders of the Respiratory System) in the ICD-10 Medicare DRG V41.0 Grouper and ICD-10 TRICARE MS DRG V41.0 Grouper. Due to this issue, MS DRG 166 (Other Respiratory System O.R. Procedures With MCC) is taking precedence over MS DRG 173/272* (Ultrasound Accelerated and Other Thrombolysis With Principal Diagnosis Pulmonary Embolism) which is causing certain claims to group to the incorrect DRG and receive incorrect reimbursement. Within the MDC 04 surgical hierarchy, MS DRG 173/272* takes precedence over MS DRG 16.","MyCare","\n4/2/2024 ","01-Hospital (Inpatient)","ETA 9/20/2024","ETA 12/16/2024","Ongoing \nremediation"]
["Unique ID: 336\nNew Potential 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\nNew Potential CPSE\nLTAC rate sheets are set to price on discharge and not admit date. ","Medicaid","2024-04-26","86-Nursing Facility","ETA  10/16/2024","ETA 1/13/2025 ","Ongoing \nremediation"]
["Unique ID: 338\nNew Potential CPSE\nThe updated May 2024 EAPG Covered Code List that has updates EAPG covered code list and adds 2 new COVID-19 codes will be configured in Molina’s system after the required 20-day turnaround requirement from the 3M release date of 6/4/2024. ","Medicaid","2024-05-07","01-Hospital (Outpatient)","ETA 10/24/2024","ETA 1/22/2025","Ongoing \nremediation"]