CLAIMS BILLING CORRECTIONS

Date: 04/06/23

Claims Incorrectly Paying EX94‒A Percentage of Billed Charges   

Claims received between March 15 and April 1, 2023, reimbursed from the practitioner fee schedule may have incorrectly paid a percentage of billed charges rather than the HFS fee schedule rate. Claims that typically pay with EX92–Paid in Full were processed with EX94–Paid at a Percentage of billed charges. This may impact Health Choice Illinois, YouthCare, and MMAI Medicaid claims. No action is needed. Claims will be reprocessed to apply the appropriate fee schedule rate no later than April 14, 2023.

Immunizations billed with CPT® 90707 and 90716 Were Incorrectly Denied as EXxa

Recently, Meridian Program Integrity implemented an edit to apply coding principles to follow the most comprehensive code for specific immunizations. The preferable coding for MMR and Varicella immunizations is the comprehensive code: CPT 90710‒MMRV.

Currently, claims billed with CPT 90707‒MMR and CPT 90716‒Varicella are applying a denial of EXxa, a component of a more comprehensive code, and paying under CPT 90710. Meridian recognizes that HFS requires reimbursement of the administration fee for each immunization given. The system is being updated to remove this code editing. Claims will be adjusted to reverse the payment under CPT 90710 and reprocess CPT 90707 and CPT 90716 to reimburse separately. No action is needed. Claims should be reprocessed by April 28, 2023. This issue is impacting claims for Health Choice Illinois and YouthCare.