Claim Records by owx87703

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New Discoveries Log
Open Discoveries Log
Closed Discoveries Log
                                                                   Provider Discovery Log - Open




Prov                                                                                  Sub-        Date
Log#    ID             Title            Type         Description           Sev.     system      Reported       ETA         Workaround          Provider Impact
   29        Client limit inquiry   Information The client limit inquiry           Client        5/19/2010    6/1/2011 Use same proceses     Providers
             function during direct al          function in                                                            used with the old
             entry in ProviderOne               ProviderOne is                                                         payment system.
                                                disabled as planned.
                                                It requires at least
                                                one year of claims to
                                                process in
                                                ProviderOne before it
                                                can be a viable tool.
                                                Once enabled,
                                                providers will be able
                                                inquire if a clients use
                                                of a service or
                                                procedure exceeds
                                                limitations.



   37        Prior Auth NPI field   Enhanceme The system and paper                 Prior Auth      6/2/2010 TBD        On a prior              Providers who submit
             label for payment      nt        form for a Prior                                                         authorization form      PA requests. (non-
             (non-pharmacy)                   Authorization (PA)                                                       (excludes pharmacy), pharmacy)
                                              request asks for the                                                     in the field requesting
                                              "Servicing" NPI. This                                                    "Servicing" NPI, use
                                              label "Servicing" may                                                    the NPI for the
                                              cause confusion and                                                      individual or group
                                              cause PA requests to                                                     who will bill DSHS for
                                              be returned because                                                      payment.
                                              you can only be paid
                                              on a PA if you are
                                              listed as a servicing
                                              provider with a "pay
                                              to" NPI. A request is
                                              being submitted to
                                              change this label to
                                              "Billing" NPI.
                                                                    Provider Discovery Log - Open




Prov                                                                                  Sub-       Date
Log#      ID            Title            Type         Description           Sev.     system     Reported      ETA         Workaround            Provider Impact
   39 105358    Remittance Advice     Enhanceme Providers have been                              6/2/2010 TBD       N/A                       Providers who use
      Claims-                         nt        giving feedback about                                                                         PDF remittance
      0569                                      the new ProviderOne                                                                           advice.
                                                Remittance Advice
                                                (RA). Themes include
                                                that the RA does not
                                                contain a few key
                                                data elements
                                                currently needed by
                                                different provider
                                                types; and the RA
                                                prints 1-3 claims per
                                                page which creates a
                                                large number of
                                                pages. A Workgroup
                                                will explore options
                                                suggested by
                                                providers to see if
                                                they are feasible and
                                                within budget
                                                constraints.




   41           Billing Inpatient Psych Information Providers billing for  N/A      Claims          6/4/2010 N/A    Do not bill inpatient     Providers billing
                Claims with old         al          inpatient psych claims                                          psych claims that         inpatient claims with
                88xxxxxx                            that have an old                                                have the old              an auth number from
                authorization number                88xxxxxx                                                        88xxxxxx                  the old system.
                                                    authorization number                                            authorization number
                                                    from the old system                                             on paper! Submit
                                                    are having difficulty                                           these claims via direct
                                                    getting these claims                                            data entry in the
                                                    paid.                                                           ProviderOne portal
                                                                                                                    and put the 88
                                                                                                                    number in the
                                                                                                                    Remarks Field and
                                                                                                                    attach the ICA form
                                                                                                                    electronically. The
                                                                                                                    claim will be
                                                                                                                    processed for
                                                                                                                    payment if the claim
                                                                                                                    data matches the ICA
                                                                                                                    form.




Click below for specific log you wish to view:
New Discoveries Log
Open Discoveries Log
Closed Discoveries Log
Prov                                                                                             Sub-     Date
Log#    ID           Title             Type               Description                   Sev.    system   Reported    ETA   Workaround     Provider Impact
   53        Crossover Claims for   Enhanceme Nursing home crossover claims are       High     Claims     7/1/2010                      After this fix has been
             Nursing Homes          nt        being received from CMS and                                                               implemented, nursing
                                              processing incorrectly through the                                                        home claims will be
                                              system                                                                                    adjusted


   54        Adjustments for     Defect         When adjusting nursing home            High    Claims    9/15/2010                      Over the weekend of
             Nursing Home claims                claims, the system is applying patient                                                  11/25 DSHS mass
                                                participation twice                                                                     adjusted all Nursing
                                                                                                                                        Home claims with
                                                                                                                                        dates of service
                                                                                                                                        1/1/2010 –
                                                                                                                                        6/30/2010. Some
                                                                                                                                        claims that were
                                                                                                                                        originally paid in
                                                                                                                                        legacy either denied
                                                                                                                                        or paid for 1 day
                                                                                                                                        instead of the entire
                                                                                                                                        date span in the
                                                                                                                                        header of the claim.
                                                                                                                                        DSHS is currently
                                                                                                                                        working on
                                                                                                                                        identifying all claims
                                                                                                                                        denied or paid in
                                                                                                                                        error. Once the
                                                                                                                                        claims are identified
                                                                                                                                        we will communicate
                                                                                                                                        an ETA for
                                                                                                                                        reprocessing the
                                                                                                                                        claims for payment.
Prov                                                                                               Sub-      Date
Log#     ID               Title           Type                Description                 Sev.    system   Reported       ETA          Workaround             Provider Impact
   58   106398 some professional       service   place of service 32,33,54,55 were      low      Claims     6/15/2010   11/13/2010 no workaround           providers billing
               claims are paying       request   incorrectly identified as facility                                                needed. Mass            professional (837P)
               facility rate rather              places of service and were paying at                                              adjustment to           claims with place of
               than nonfacility rate             the (lower) facility rate in error                                                reprocess the           service 32,33,54,55
                                                                                                                                   affected (effected?)    were paid at the
                                                                                                                                   claims is in process.   (lower) facility rate in
                                                                                                                                                           error
   59



Click below for specific log you wish to view:
New Discoveries Log
Open Discoveries Log
Closed Discoveries Log
17            Pharmacy claim          Informati   Paid pharmacy             Med     Pharmac    ##########   N/A           Wait for 5/24
              warrants                onal        claims received from              y                                     warrant
                                                  4/28 to 5/9 will be
                                                  on the 5/17 warrant
                                                  (5/10 and 5/11 paid
                                                  pharmacy claims will
                                                  not be on 5/17
                                                  warrant, they will be
                                                  included on the
                                                  5/24) warrant

18            Benefit Inquiry         Informati   ProviderOne has no        Low                ##########    6/1/2010     Use the legacy
              Missing May RSN         onal        historical RSN                                                          process until
              Managed Care                        history, which                                                          6/1/2010.
              History                             means there is no
                                                  RSN information to
                                                  return on the
                                                  eligibility inquiry or
                                                  use to identify non-
                                                  citizen children.

19            High denial rate of     Configura   ADA dental claims         N/A                ##########   TBD           Complete fields 20,
              dental claims           tion        are denying for                                                         21, and 22 -- even if
                                      Change      missing information                                                     "self" is selected in
                                                  in fields 20, 21, and                                                   box 18 until the
                                                  22. These field are                                                     configuration
                                                  NOT required per                                                        change is complete.
                                                  the 2009-2010 ADA
                                                  Dental rules IF you
                                                  selected" self" in
                                                  box 18. However, if
                                                  these fields are not
                                                  complete, the claim
                                                  will currently deny
                                                  even if "self" is
                                                  selected in box 18.



20   TBD      Retreiving Claims       Defect      Converted images          Mediu   Claims     ##########      TBD        Go to the Claim
              Images                              from the old system       m                                             Retreival page and
                                                  have not been                                                           type the TCN to
                                                  attached to claim                                                       retreive the image
                                                  records yet - paper                                                     until the paper clip
                                                  clip not working                                                        is working

21   TBD      Provider Claims         Defect      System hangs or           High    Claims     ##########   5/17/2010     Log out and log back
              Inquiry issue when                  doesn't find claim                                                      and try again, OR
              searching by client                 when searching by                                                       search by TCN
              ID and date of                      client ID and date of                                                   instead
              service                             service
22   TBD      Faxed Pharmacy PA       Defect      Faxed pharmacy            High    Corresp    ##########   TBD           Staff are entering
              Requests                            prior authorization               ondence                               req'd fields until a
                                                  requests are being                                                      fix is in place to
                                                  received, but due to                                                    automatically enter
                                                  data issues on the                                                      default values. Faxes
                                                  original fax (missing                                                   are being received
                                                  required fields) they                                                   and can be viewed
                                                  are hanging up in                                                       by client.
                                                  the work queues.

23            Direct Entry Claim      Informati   Providers who are         N/A     N/A        ##########   N/A           Providers should
              Submission              onal        directly entering                                                       complete
                                                  claims in                                                               submission by
                                                  ProviderOne are not                                                     clicking the "OK"
                                                  completing the claim                                                    button. A tip sheet
                                                  submission by                                                           is available at
                                                  clicking "OK". If the                                                   http://hrsa.dshs.wa.
                                                  button is not                                                           gov/providerone/
                                                  clicked, the                                                            documentation/
                                                  transaction is                                                          clicksubmitclaimbutt
                                                  voided and the                                                          on.pdf
                                                  provider will have to
                                                  re-enter.
24            Resuming Self-          Defect      When an existing          Low     Provider   ##########    6/7/2010     Providers who are
              Enrollment of                       billing provider adds                                                   adding new servicing
              Servicing Providers                 a new servicing                                                         providers should
                                                  provider and does                                                       complete all steps of
                                                  not finish the                                                          the enrollment
                                                  enrollment, they                                                        wizard and submit
                                                  cannot get back to                                                      for approval until
                                                  the record to                                                           the defect is
                                                  complete it. Also,                                                      correctted. After
                                                  the "tracking"                                                          the defect is
                                                  feature is not                                                          corrected, billing
                                                  available until the                                                     providers will have
                                                  defect is fixed.                                                        access to any
                                                                                                                          servicing provider
                                                                                                                          enrollments they
                                                                                                                          started but did not
                                                                                                                          finish.

25            Pharmacy Claim          Informati   Paid pharmacy             Mediu   Pharmac    ##########   N/A           Wait for 5/31
              Warrants                onal        claims for 5/18 will      m       y                                     warrant
                                                  not be on the 5/24
                                                  warrant. These
                                                  claims will be on the
                                                  5/31 warrant.
26            Known Issue with        Informati   There is a known          TBD     N/A        ##########   TBD           DSHS IT staff are
              reports and xls         onal        compatibility issue                                                     working with various
              format                              with some of the                                                        vendors to find a
                                                  reporting tools and                                                     solution. When
                                                  the ability to export                                                   possible export to
                                                  to Excel.                                                               an alternate format.




27   N/A      Blue Forms will be      Informati   The Department will               Imaging    ##########   N/A           N/A
              returned to             onal        return any
              providers (except                   adjustments
              pharmacies)                         submitted on the
                                                  Bluepaper form -
                                                  with the exception
                                                  of pharmacies.
                                                  Refer to the
                                                  ProviderOne Billing
                                                  and Resource Guide
                                                  for the appropriate
                                                  forms.

28            Accessing the           Informati   Providers are having      Mediu   IVR/Clie   ##########   TBD           The ProviderOne
              ProviderOne Client      onal        difficulty obtaining      m       nt                                    client ID is printed
              ID Number                           the new                                                                 on the Services Card
                                                  ProviderOne client                                                      and available in a
                                                  ID when clients                                                         crosswalk tool for
                                                  don't have a Services                                                   clients that you have
                                                  Card. We are adding                                                     been paid for in the
                                                  the new ID to the                                                       past two years and
                                                  automated                                                               have the Personal
                                                  telephone system                                                        Identfication Code
                                                  response. We are                                                        (PIC) for from the
                                                  developing a one-                                                       old system. You can
                                                  for-one look up tool                                                    also do an eligibility
                                                  for clients who were                                                    inquiry in
                                                  eligible in the old                                                     ProviderOne with
                                                  system in the past                                                      other information
                                                  two years (you will                                                     like name, social
                                                  need to know the                                                        security number,
                                                  Personal                                                                and date of birth.
                                                  Identification Code
                                                  (PIC) from the old
                                                  system. We are
                                                  enhancing the
                                                  search parameters in
                                                  ProviderOne.



30            Navigating 1-800-       Informati   Providers are                     IVR        ##########   N/A           A fact sheet is
              562-3022                onal        reporting that the 1-                                                   published to assist
                                                  800-562-3022 is                                                         providers with
                                                  difficult to navigate                                                   navigation and to
                                                  and the voice                                                           show the telephone
                                                  recognition is                                                          key pads that can be
                                                  challenging.                                                            used rather than
                                                                                                                          voice prompts
                                                                                                                          http://hrsa.dshs.wa
                                                                                                                          .gov/providerone/P
                                                                                                                          roviders/Fact%20Sh
                                                                                                                          eets/P1PR016.pdf



31            Nursing Home            Defect      ProviderOne has                              ##########    6/7/2010     Hold adjustments
              Adjustments                         discovered a defect                                                     until after 6/7/2010.
                                                  that prevents
                                                  provider initiated
                                                  adjustments from
                                                  processing correctly.



32            Fax Lines Busy                      Providers getting a                          ##########   5/19/2010     N/A
                                                  fast busy on FAX                                           11:00
                                                  lines                                                     a.m. (FAX
                                                                                                            servers
                                                                                                            reset
                                                                                                            which
                                                                                                            corrected
                                                                                                            this issue)
33            Warrant Information     Informati   Providers are                                ##########   N/A           N/A
                                      onal        reporting they
                                                  cannot access
                                                  warrant information.
                                                   While some
                                                  providers may
                                                  receive checks as
                                                  early as Friday
                                                  following the
                                                  Wednesday
                                                  payment cycle,
                                                  Warrant
                                                  information/Remitta
                                                  nce Advice will be
                                                  available no later
                                                  than the Monday
                                                  following a payment
                                                  cycle.

34            WINASAP file            Defect      ProviderOne was                              ##########                  If your claim file has
                                                  informed by ACS                                                         an upload date of
                                                  (WINASAP vendor)                                                        5/19 and you
                                                  that no WINASAP                                                         submitted earlier,
                                                  files were                                                              your claims did not
                                                  accepted/processed                                                      make this weeks
                                                  on 5/18.                                                                payment cycle
35    1E+05   837 Dental Batch        Defect      Dental providers are      High    Claims     ##########   6/28/2010     Until the batch
              Files containing                    submitting                                                              process is fixed
              Appliance Placement                 Appliance Placement                                                     providers can enter
              Date                                Date on the 837                                                         claims that carry
                                                  dental batch claims,                                                    appliance placement
                                                  however, the                                                            date through direct
                                                  information is not                                                      entry in the
                                                  mapped in                                                               ProviderOne web
                                                  ProviderOne so                                                          portal or on paper.
                                                  claims are
                                                  incorrectly denying

36    1E+05   Point of Sale (POS)     Change      In the old payment        High    POS        ##########   TBD -         The information is
              835 data                Request     system, the ACS 835                                       change        available on the
                                                  transaction returned                                      request is    ProviderOne PDF
                                                  prescription number                                       in process    Remittance Advice
                                                  for POS claims in                                         of being
                                                  data element CLP01.                                       developed.
                                                   ProviderOne does                                          The
                                                  not return the                                            change
                                                  information on the                                        request
                                                  835.                                                      includes a
                                                                                                            request to
                                                                                                            have CNSI
                                                                                                            recycle all
                                                                                                            previous
                                                                                                            pharmacy
                                                                                                            835's to
                                                                                                            return the
                                                                                                            prescriptio
                                                                                                            n number
                                                                                                            in data
                                                                                                            element
                                                                                                            CLP01
38    1E+05   Providers               TBD         The Department is                 Claims     6/4/2010     8/16/2010     If you are
              Resubmitting claims                 analyzing an issue                                                      resubmitting a claim
              via Direct Data Entry               reported by                                                             and receive a SQL
                                                  providers that                                                          error, you can
                                                  occurs when                                                             submit a new claim.
                                                  providers are trying
                                                  to resubmit claims
                                                  via direct data entry.
                                                  When providers
                                                  change data they
                                                  sometimes receive a
                                                  SQL error message.
                                                  We are researching
                                                  which data element
                                                  is causing the error.



40    1E+05   HIPAA 835 data          Defect      The BPR11 and                     EDI        6/4/2010     8/16/2010
              elements BPR11 and                  TRN04 data
              TRN04                               elements within the
                                                  835 transaction
                                                  must match. The
                                                  ProviderOne
                                                  Companion Guides
                                                  reference the same
                                                  data elements (WA
                                                  DSHS). However,
                                                  the 835 is returning
                                                  different data
                                                  elements. BPR11 is
                                                  returning "WA
                                                  DSHS" (3 spaces
                                                  between WA and
                                                  DSHS) and TRN04 is
                                                  returning "WA
                                                  DSHS" (1 space
                                                  between WA and
                                                  DSHS).

42    1E+05   TPL information on                  Remittance Advice                            6/2/2010     TBD           Several
              Remittance Advice                   (RA) is showing                                                         enhancements are in
                                                  Third Party Liability                                                   progress to correct
                                                  (TPL) information                                                       these issues. Until
                                                  that is not current,                                                    then, you may see
                                                  appropriate or                                                          extra TPL
                                                  necessary. We are                                                       information on your
                                                  seeing sometimes                                                        RA. For example,
                                                  the client TPL                                                          you may have seen
                                                  information printing                                                    the client's Part D
                                                  on the RA regardless                                                    information whether
                                                  if the insurance                                                        or not they denied
                                                  coverage has ended                                                      for TPL. Some
                                                  prior to the dates of                                                   information that
                                                  service.                                                                may be helpful: First,
                                                                                                                          look at the reasons
                                                                                                                          the claim was
                                                                                                                          denied, the last
                                                                                                                          column on the line.
                                                                                                                          Claims denied for
                                                                                                                          TPL reasons most
                                                                                                                          often have an
                                                                                                                          adjustment/denial
                                                                                                                          reason code of 22.
                                                                                                                          If it was denied for
                                                                                                                          TPL reasons, then
                                                                                                                          you can look at the
                                                                                                                          TPL information on
43    1E+05   Daily Transportation    Defect      Ongoing issues with       TBD     Data       6/7/2010     TBD           Refer to the weekly
              Broker File                         daily Transportation              conversi                              eligibility file.
                                                  Broker eligibility                on
                                                  files. Only weekly
                                                  file will be sent until
                                                  problem resolved.



44   N/A      ProviderOne Benefit     Informati   ProviderOne's                     Client     6/8/2010                   For clarification, you
              Inquiry Screen          onal/Enh    Benefit inquiry                                                         can read the fact
                                      ancement    screens show                                                            sheet "Choosing the
                                                  enhanced managed                                                        Appropriate
                                                  care information --                                                     Provider from the
                                                  more than what was                                                      Managed Care
                                                  shared in the past.                                                     Information Screen"
                                                  Some of it is not                                                       at
                                                  applicable to clients                                                   http://hrsa.dshs.wa.g
                                                  only accessing                                                          ov/providerone/doc
                                                  medical services.                                                       umentation/RSNs-
                                                  This has caused                                                         ManagedCare.pdf
                                                  some confusion for
                                                  providers trying to
                                                  coordinate Managed
                                                  Care Services. Text
                                                  will be added to the
                                                  ProviderOne screens
                                                  to make the Regional
                                                  Support Network
                                                  (RSN) information
                                                  more
                                                  understandable and
                                                  the chronic care will
                                                  be removed.
  45    1E+05   ProviderOne 835           Change    The ProviderOne          High    EDI       ##########   TBD -         Until the change to
                does not return           Request   835 remittance                                          change        the system can be
                prescription                        advice does not                                         request is    made, pharmacy
                numbers                             capture the                                             in process    providers can try to
                                                    prescription number                                     of being      use the PDF RA
                                                    and return it to                                        developed.    because it does
                                                    providers in data                                        The          contain the
                                                    element CLP01. The                                      change        prescription
                                                    department has                                          request       number. The
                                                    requested the                                           includes a    Department
                                                    system vendor to                                        request to    recognizes that is a
                                                    change the system                                       have CNSI     labor intensive
                                                    to return the                                           recycle all   workaround and not
                                                    prescription number                                     previous      a long-term solution.
                                                    in data element                                         pharmacy
                                                    CLP01 (as it was in                                     835's to
                                                    the old payment                                         return the
                                                    system). The change                                     prescriptio
                                                    request also asks                                       n number
                                                    that all all previous                                   in data
                                                    835's prior to the                                      element
                                                    change are                                              CLP01
                                                    reprocessed so that
                                                    they will show the
                                                    prescription number.



  46    1E+05   Seattle Children's        Defect    Seattle Children's               EDI       7/2/2010     8/16/2010     If this situation
                270/271 batch issue                 reported that they                                                    occurs, use the
                                                    used clients Full                                                     270/271 direct
                                                    Name and Date of                                                      entry screens in
                                                    Birth as the search                                                   ProviderOne until
                                                    criteria on the 270                                                   the defect is
                                                    batch transaction                                                     corrected.
                                                    but the 271
                                                    response did not
                                                    return client
                                                    eligibility
                                                    information for
                                                    some of the clients.
                                                    However, the client
                                                    eligibility
                                                    information would
                                                    be returned when
                                                    the same Full Name
                                                    and Date of Birth
                                                    was used in the
                                                    ProviderOne
                                                    270/271 direct data
                                                    entry screens

  47    1E+05   Bilateral Pricing Error   Defect    The system is                              7/7/2010     TBD
                                                    inappropriately
                                                    applying bilateral
                                                    pricing to
                                                    Professional Claims
                                                    causing claims to
                                                    deny and/or price in
                                                    error.

  48            Denial EOB 181 for        Issue     Professional claims      Mediu   Claims    7/7/2010     In process    No workaround
                professional claims                 processed on July        m                                            needed. Claims
                processed on July 2,                2nd were incorrectly                                                  processed after July
                2010                                denied with EOB                                                       4th are processing
                                                    181, indicating that                                                  correctly. The
                                                    the procedure code                                                    Department is
                                                    was not valid.                                                        correcting the claims
                                                                                                                          that denied in error.
                                                                                                                          No action is
                                                                                                                          required providers.



  49    1E+05   Screen level error        Defect    When a provider                  Claims    ##########   8/16/2010     Until the fix is in
                during Direct Data                  enters a claim                                                        place, providers will
                Entry(DDE) of                       through DDE that                                                      need to go back to
                multiple claims                     requires TPL                                                          the ProviderOne
                requiring Third Party               information, after all                                                Portal page to start
                Information (TPL)                   data is entered                                                       the next claim to
                                                    correctly, the claim                                                  avoid the screen
                                                    will be loaded into                                                   level error. After the
                                                    ProviderOne                                                           fix is in place,
                                                    correctly. When the                                                   providers should be
                                                    screen is refreshed,                                                  able to refresh the
                                                    and the provider                                                      claim page and
                                                    tries to enter                                                        submit the next
                                                    subsequent claims                                                     claim without going
                                                    with TPL                                                              back out to the main
                                                    information, a                                                        page.
                                                    screen level error
                                                    message will be
                                                    received.
  50   10521    Direct Data Entry         Defect    This defect prevents                       8/3/2010     9/12/2010     Providers should
       7-       Third Party Liability               providers from                                                        hold off on adding
       Ready    (TPL) Adjustment                    adding electronic                                                     TPL HIPAA
       Promot   Reason Codes                        TPL HIPAA                                                             adjustment reason
       e-                                           adjustment reason                                                     codes to DDE claims
       PROD                                         codes to a direct                                                     until after the defect
                                                    entry claim.                                                          is corrected. Once
                                                                                                                          the defect is
                                                                                                                          corrected, you will
                                                                                                                          be able to add the
                                                                                                                          TPL HIPAA
                                                                                                                          adjustment reason
                                                                                                                          code after you add
                                                                                                                          the service line item.
                                                                                                                          You will click on the
                                                                                                                          Other Service Info
                                                                                                                          hyperlink at the end
                                                                                                                          of your line. Fill out
                                                                                                                          the Service Line
                                                                                                                          Adjudication
                                                                                                                          information under
                                                                                                                          the Other Line Item
                                                                                                                          Information section.
                                                                                                                           Make sure to
                                                                                                                          include a comment
                                                                                                                          "Electronic TPL".


  51    1E+05   Baby On Mom's ID          System    Providers are            Mediu   HIPAA/C   8/2/2010     9/27/2010
                billing issue             Defect    following the            m       laims
                                                    guidelines for billing
                                                    Baby on Mom's ID
                                                    set forth in memo
                                                    10-18, but the
                                                    system did not
                                                    correctly capture the
                                                    baby's information.
                                                    The system then
                                                    processed the claim
                                                    incorrectly.

  52    1E+05   Claims Pricing at         Defect    Various procedure        High    Claims    ##########   Will be
                zero problem                        codes are pricing at                                    promoted
                                                    zero in error; and, is                                  to
                                                    known to be                                             productio
                                                    impacting                                               n on
                                                    “Maternity Support                                      9/25/2010
                                                    Services/Infant Case
                                                    Management”,
                                                    "Child Birth
                                                    Education" and
                                                    “Outpatient
                                                    Chemical
                                                    Dependency”
                                                    programs.

  55            Part B crossovers         Defect    Part B crossovers        Med     Claims    ##########   ##########    none, claims will be
                for Pharmacy                        for Pharmacy                                                          reprocessed
                providers are                       providers                                                             (recouped) after
                overpaying                          (taxonomy begins                                                      system correction.
                                                    with 3336) are not
                                                    having the Medicare
                                                    paid amount
                                                    deducted from the
                                                    allowed amount
       106316
  56    1E+05   some claims for           defect    Family                   High    Claims    approxima    11/8/2010     none. – We will
                family                              planning/takecharge                        tely                       work to identify and
                planning/takecharge                 clients have limited                       7/1/2010                   correct any claims
                clients are paying in               scope of care. We                                                     paid incorrectly
                error and/or denying                have noticed that                                                     once the fix is
                in error                            some claims are                                                       implemented
                                                    denying in error and
                                                    some claims are
                                                    paying in error

  57    1E+05   DME providers                       There was a problem              Claims                 cleanly
                only/tax rate                       where taxable                                           adjusted
                adjustment                          procedure codes on                                      claims
                                                    claims with a prior                                     should
                                                    authorization were                                      show on
                                                    not paying sales tax.                                   your RA
                                                    It was discovered                                       dated on
                                                    the system was                                          or about
                                                    limiting payments                                       11/13/10
                                                    based on what was
                                                    authorized. If the
                                                    allowed amount was
                                                    the same as the
                                                    authorized amount
                                                    or if the allowed
                                                    amount plus sales
                                                    tax was more than
                                                    the authorized
                                                    amount, the system
                                                    only paid up to the
                                                    authorized amount
                                                    in the prior
                                                    authorization. It
                                                    should have paid
                                                    the authorized
                                                    amount plus sales
                                                    tax. ProviderOne is
                                                    now paying these

Cl i ck bel ow for s peci fi c l og you wi s h to vi ew:
New Di s coveri es Log
Open Di s coveri es Log
Cl os ed Di s coveri es Log

								
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