Alerts & Notices/Provider Remittance Advice Impacts
(10/2013)
10/2013
Alerts and Notices
Claim Denials for Ordering/Referring in Error
Impacted Providers
• Part B CA, NV, HI
Description
• Claims are being denied PR-16 with additional messages N264 and N265 for Ordering/Referring
Applicable claims/procedure code(s)
• Claims with certain services requiring ordering/referring providers that processed on or after 9/16/13.
Noridian Action
• Noridian identified some editing issues for the JE claims processing system. The services affected should not have denied, rather it should have been an informational message only. The system has being updated as of 9/27/13. Providers may continue to receive the incorrect denials for claims currently in process.
• Noridian is identifying the claims affected and will reprocess the claims. This will be done in two phases, one on Monday 9/30/13 and phase two in two weeks. This will allow us to capture any claims that may be on the payment floor.
• 10/04/13 - Noridian has completed Phase 1 of 3 by adjusting claims that were finalized prior to 9/27/13.
• Phase 2 will be run on/about 10/21/13 and will capture any claims that were still processing during first phase.
• Phase 3 We have added a third phase the will be run on/about 10/30/13 to capture any remaining affected claims not previously adjusted.
Provider Action
• No action needed.
Date Identified
• 9/26/13
• Last Updated Oct 03, 2013
Provider Remittance Advice Impacts as a Result of the Jurisdiction E Part B MAC Transition
Noridian has identified an impact to the content of the provider remittance advices as a result of the transition of pending workload from Palmetto GBA (PGBA) to Noridian.
Providers may notice the Glossary, Group, Reason, MOA, Remark and Adjustment Codes section of their remittance may contain verbiage that does not match the services provided. The group codes and liability assigned to payments and denials may also be incorrect.
One example providers may notice is for claims that previously displayed CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee Arrangement) for payment. These paid claims may incorrectly display on the remittance as a PR-150 (Payer deems the information submitted does not support this level of service). As of 9/20/2013, this has been updated in Noridian's system. Please be aware that remittances generated on or after 09/20/13 may still show the incorrect verbiage depending on the status of the claim when the system was updated.
Noridian is currently working to correct history and provide corrected remittance advices to impacted providers. Additional updates will be provided when they are available.
Last Updated Sep 27, 2013