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["\n\n\n\n\n","Molina Healthcare of Ohio \nClaims Payment Systemic Errors ",null,null,null,"SEPTEMBER 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:269\nConfirmed 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","2023-07-06","Workaround started 4/24/2023\nAdjustment Batch 1 ETA 9/12/2023-10/24/2023\nAdjustment Batch 2 ETA 9/12/2023-10/24/2023\nAdjustment Batch 3 ETA 9/12/2023- 10/24/2023\nRecovery Batch 1 ETA 9/12/2023-9/27/2023\nRecovery Batch 2 ETA 9/12/2023-9/27/2023","Fix is complete"]
["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","Adjustment batch 1 Completed 7/17/2023\nAdjustment batch 2 Completed 8/14/2023\nAdjustment batch 3 Completed 8/24/2023","Complete"]
["Unique ID:275\nConfirmed 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","2023-07-10","Checks reissued 4/20/2023, 5/9/2023, 5/18/2023, 5/25/2023, 6/13/2023, 6/20/2023, 8/10/2023","Fix is complete"]
["Unique ID:279\nConfirmed CPSE:\nOn 12/1/2022 Cotiviti’s CV Edit 6268 DP 11471 was turned on, modification wasn’t made to exclude chiropractors from edit. They should be excluded due to ODM’s guidance and allowing chiropractor’s to bill an E/M with spinal manipulation on the same day with modifier 25 and the NCCI bundle would be bypassed for these services.   ","2023-06-16","27-Chiropractor Individual","2023-07-23","Adjustment ETA 8/30/2023-10/12/2023","Fix is complete"]
["Unique ID:281\nConfirmed CPSE:\nBH claims are incorrectly denying for inconsistent modifier(s) for providers with QMHS Specialties.","2023-06-23","84-Ohio Department of Mental Health (Community Mental Health) Provider ","2023-08-25","Adjustment Batch 1 Completed 9/8/2023\nAdjustment Batch 2 ETA 8/24/2023-10/6/2023","Fix is complete"]
["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.","2023-07-13","01-Hospital (Outpatient)","2023-08-15","ETA 1/9/2024\n","Fix is complete"]
["Unique ID:283\nPotential CPSE:\nCodes A9595 and A9587 were missed during the PAP fee Schedule update on Professional Contracts.\nAfter Final Review, NOT A CPSE \n","2023-07-17","21-Professional Medical Group","2023-07-28","After Final Review, NOT A CPSE ","Complete"]
["Unique ID:284\nConfirmedl CPSE:\nProviders that submit claims with attachments through Availity, the submission is either completely missing the attachment or the attachment is being delay causing some claims to deny.","2023-07-19","00-All provider types","ETA 11/16/2023","Adjustment Completed 9/12/2023","Ongoing \nremediation"]
["Unique ID:285\nPotential CPSE:\nBH providers with specialty listed of Nurse Practitioner claims are denying for Ordering Provider in error.","2023-07-28","84-Ohio Department of Mental Health (Community Mental Health) Provider ","ETA 11/25/2023","ETA 1/24/2024","Ongoing \nremediation"]
["Unique ID:286\nPotential CPSE:\nMolina’s claim loader experienced intermittent slowness which causes incomplete loads in the pre-adjudication database.","2023-08-02","21-Professional Medical Group\r\n95-ODADAS Certified/Licensed (SUD) Treatment Program","ETA 11/30/2023","Workaround started 8/18/2023","Ongoing \nremediation"]
["Unique ID:287\nConfirmed CPSE:\nCOBA Claims files were not received from CMS due to an inadvertent pause placed on the claims ingestion process related to a process go-live which was not returned to operational status after the technical effort was completed. ","2023-07-13","00-All provider types","2023-08-17","Processed claims 8/17/2023 thru 8/23/2023","Complete"]
["Unique ID:288\nPotential CPSE:\nClaims for B4157-B4162 that requires an Invoice are paying in error when claim is received without the invoice. \n","2023-08-03","76-Durable Medical Equipment Supplier","2023-08-10","ETA 1/30/2024","Fix is complete"]
["Unique ID:289\nPotential CPSE:\nInpatient claims with DOS that span before and after 7/28/23 are pricing incorrectly.\n","2023-08-09","01-Hospital (Inpatient)","2023-09-05","ETA 2/5/2024","Fix is complete"]
["Unique ID:290\nPotential 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.","2013-08-10","01-Hospital (IP & OP)","2023-08-22","ETA 2/6/2024","Fix is complete"]
["Unique ID:291\nNew Confirmed CPSE:\nMCPF solution is denying claims in error when the provider is actively registered with ODM.","2023-08-14","00-All provider types","2023-08-29","Adjustment Batch 1 ETA 8/30/2023-10/12/2023\nAdjustment Batch 2 Completed 9/8/2023","Fix is complete"]
["Unique ID:292\nNew Potential CPSE:\nOptum has identified an issue with the fee schedule rates for the Opioid Treatment Program (OTP) procedure codes  G2069-G2070, G2072-G2073. Incorrect fee schedule rates for these codes were inadvertently included in the APC and Physician Fee Schedule Data Files, effective January 1, 2023.  As a result, claim lines submitted with one of these procedure codes for dates of service on or after January 1, 2023, will receive incorrect reimbursement. ","2023-08-14","01-Hospital (Outpatient)","2023-08-22","ETA 2/10/2024","Fix is complete"]
["Unique ID:293\nNew Potential CPSE:\nOn 8/15/23, one of our vendors reported a system error affecting add-on codes causing them to deny in error. The configuration saver tool was used to load the Q3 Knowledgebase on 8/12/23, this caused the files to return errors.\n","2023-08-15","00-All provider types","2023-08-15","ETA 2/12/2024","Fix is complete"]
["Unique ID:294\nNew Potential CPSE:\nOutpatient hospital Medicare 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","2023-08-21","01-Hospital (Outpatient)","ETA 12/19/2023","ETA 2/17/2024","Ongoing \nremediation"]
["Unique ID:295\nNew Potential CPSE:\nOptum incorrectly calculating LTCH reimbursement for claims with a Thru or Discharge Date on or after May 12, 2023 and a From or Admission Date prior to May 12, 2023.","2023-09-06","00-All provider types","ETA 2/27/2024","ETA 5/21/2024","Ongoing \nremediation"]
["Unique ID:296\nNew Potential CPSE:\nServices should have been configured within the non-par lab contract. ","2023-09-09","00-All provider types","ETA 3/2/2024 ","ETA 5/24/2024","Ongoing \nremediation"]