Provider Claim Alerts
Update: As of 9/21/23, Meridian identified and resolved the source of EDI claim rejections that occurred between 9/16 and 9/20. Meridian’s clearinghouse inadvertently directed claims to an incorrect claims platform rather than the correct Meridian claims system. As of 9/21/23, all of the misdirected claims were resent by the clearinghouse to the correct claims system. Providers do not need to resubmit any of the claims that were rejected between 9/16 and 9/20. Note: as a result of the resubmission, some claims may reject a second time appropriately. If you have any questions, please reach out to customer service at 866-606-3700 or contact provider relations.
Please review the below information on known claim processing issues and action items to resolve.
System Configuration Issues: These issues occur when the claims system is not configured to pay claims per guidelines. In most cases no action is needed by provider as Meridian will automatically reprocess impacted claims once the system configuration is corrected. If providers will be required to resubmit claims, information will be posted below in the Details section.
Billing Opportunities: When Meridian identifies an opportunity for clarification of billing requirements, information will be posted to allow providers an opportunity to submit a corrected claim for adjusted reimbursement as appropriate
If you have a claim that should be included in one of the claim projects below (which you believe denied incorrectly) and it has not yet been adjusted as of the date the project is closed, please let us know the claim number so that we can research it and confirm. You may confirm claim status via the Meridian Service Portal (preferred), contacting the call center at 866-606-3700 or reach out to your provider contact for more information.
Rescinded Recovery Projects: At times, Meridian may find cause to cancel a recovery project. When this occurs. Meridian has determined that the notification of overpayment is rescinded. If you received an overpayment notification and you find the project number referenced in that notification on this list, you do not need to take any further action. The project has been canceled an claims will not be recouped. To find the project number of the rescinded Recovery projects, please review your notice in the upper right hand corner and you will see the project number listed. Please retain a copy of the recovery letter for reference if needed in the future.
Behavioral Health Billing Quick Tips
Find Behavioral Health Billing Quick Tips for proper billing of behavioral health (BH) claims to Meridian for Illinois HFS HealthChoice Illinois (YouthCare) programs, here.
Issue Resolution Status Key
- Research: Issue is being investigated, no action needed at this time. Please monitor this page for further information.
- Solution Identified: Root cause of the issue has been identified, but system update is not yet completed.
- Resolution Deployed: System has been fixed, current claims processing correctly, claims reprocessing will occur for prior claims.
Project Status Key
- Creation: Meridian is in the process of identifying the impacted claims.
- In Progress: The project is actively being worked and payments will begin to be issued.
- Batch Complete: Most claims in the project have been systematically reprocessed with the exception claims which have fallen to manual reprocessing.
- Completed: Claims included in the claim project have reprocessed. Note, this is not a guarantee of payment, during the reprocessing of claims may hit additional claim edits.
For questions about global issues or the associated claims projects, please contact Provider Services or reach out to your provider contact for more information.
System Configuration
Updated 11/14/2024
| Open Issues | Impacted Provider Types | Impacted Program(s) | Details | Issue Resolution status | Claim Project Status | Target Completion Date* |
|---|---|---|---|---|---|---|
| HBIC | All | HealthChoice | HBIC (Notice Date 11/1/24) (PDF) | Research | Creation | 11/30/2024 |
| FQHC/RHC Claims Denying EX4B | FQHC/RHC | HealthChoice, Youthcare, MMAI Medicaid | FQHC/RHC Claims Denying EX4B (Notice Date 10/7/24) (PDF) | Solution Identified | Creation | 11/30/2024 |
| Claims Denying EXcL | All Providers | HealthChoice, Youthcare, MMAI Medicaid | Claims Denying EXcL (Notice Date 11/5/24) (PDF) | Resolution Deployed | Creation | 11/30/2024 |
*Project completion is when the batch process has finished. Not inclusive of manual changes.
Billing Opportunities
| Issue | Provider Type | Guidance |
|---|---|---|
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Completed Projects
Below is a listing of completed claim projects. If you have a claim that should be included in one of the completed claim projects below (which you believe denied incorrectly) and it has not yet been adjusted, please let us know the claim number so that we can research it and confirm. Please reach out to your provider contact for more information.
| ISSUE | IMPACTED PROVIDER TYPES | DETAILS | ISSUE RESOLUTION STATUS | CLAIM PROJECT STATUS |
|---|---|---|---|---|
| MMAI Medicaid Claims Paying Incorrectly | DME/Physician/Specialist | MMAI Medicaid Claims Paying Incorrectly (Notice Date 8/29/24) (PDF) | Resolution Deployed | Completed |
| CPT® 99202-99215 Underpayments | All Providers | CPT® 99202-99215 Underpayments (Notice Date 2/5/24) (PDF) | Resolution Deployed | Completed |
| Claims Denying EXEC | All Providers | Claims Denying EXEC (Notice Date 9/16/24) (PDF) | Resolution Deployed | Completed |
| LARC Denials for FQHC/RHC | FQHC/RHC | LARC Denials for FQHC/RHC (Notice Date 7/12/24) (PDF) | Resolution Deployed | Completed |
| SNF Claims Paying 25% of Billed Charges | Supportive Living | SNF Claims Paying 25% of Billed Charges (Notice Date 07/31/24) (PDF) | Resolution Deployed | Completed |
| Claims Denying EXGT for G2025 | All Providers | Claims Denying EXGT for G2025 (Notice Date 12/1/23) (PDF) | Resolution Deployed | Completed |
| Maternal Child Add-on Not Reimbursing | All Providers | Maternal Child Add-on Not Reimbursing (Notice Date 5/13/2024) (PDF) | Resolution Deployed | Completed |
| Maternal Child Indicator for Nurse Practitioners | All Providers | Maternal Child Indicator for Nurse Practitioners (Notice Date 1/22/24) (PDF) | Resolution Deployed | Completed |
| CPT®95165 Underpaying | All Providers | CPT®95165 Underpaying (Notice Date 1/22/24) (PDF) | Resolution Deployed | Completed |
| CPT®90677 Denying Incorrectly | All Providers | CPT®90677 Denying Incorrectly (Notice Date 1/3/24) (PDF) | Resolution Deployed | Completed |
| Incorrect Coding Denials for limited E HCPCS DME | All Providers | Claims for certain DME service billed with E codes are incorrectly denying the supply codes with EXys (Notice Date 7/5/2023) (PDF) | Resolution Deployed | Completed |
| Patient Credit File (PCF) Recoupment Overpayment | All Providers | Overpayment due to retroactive eligibility update (Notice Date 6/30/2023) (PDF) | Resolution Deployed | Completed |
| Waiver Code Overpayment | Waiver Providers | Waiver fee schedule has been changed (Notice Date 6/30/2023) (PDF) | Resolution Deployed | Completed |
| HCPCS G0008 and G0009 paying @25% of billed charges | All Providers | HCPCS G0008 and G0009 paying @25% of billed charges (Notice Date 8/29/22) (PDF) | Resolution Deployed | Completed |
| Discarded Drugs billed with modifier JW paying in error | All Providers | Discarded Drugs billed with modifier JW paying in error (Notice Date 5/5/23) (PDF) | Resolution Deployed | Completed |
| Immunizations billed with CPT® 90707 and 90716 Were Incorrectly Denied as EXxa | All Providers | Immunizations billed with CPT® 90707 and 90716 Were Incorrectly Denied as EXxa (Notice Date 4/6/23) (PDF) | Resolution Deployed | Completed |
| Claims Denying EX35 for 97110 | All Providers | Claims Denying EX35 for 97110 (Notice Date 8/4/23) (PDF) | Resolution Deployed | Completed |
| Optical Visits not reimbursing fee for service FQHC and RHC | FQHC and RHC | Optical Visits not reimbursing fee for service FQHC and RHC (Notice Date 9/14/23) (PDF) | Resolution Deployed | Completed |
| DME Orthotics Codes denying EX46 | Orthotic and Prosthetic | DME Orthotics Codes denying EX46 (Notice Date 9/14/23) (PDF) | Resolution Deployed | Completed |
| Claims Denying for G8510 and G8431 for Depression Screening | All Providers | HFS added HCPCS codes G8510 and G8431 (Notice Date 7/5/2023) (PDF) | Resolution Deployed | Completed |
| Therapy claims paying the incorrect rate | All Providers | Therapy claims paying the incorrect rate (Notice Date 7/5/23) (PDF) | Resolution Deployed | Completed |
| Claims billed with modifier 95 denying EX86 in error | All Providers | Claims billed with modifier 95 denying EX86 in error (Notice Date 5/5/23) (PDF) | Resolution Deployed | Completed |
| IP claims paying incorrect DRG | All Providers | IP claims paying incorrect DRG (Notice Date 7/5/2023) (PDF) | Resolution Deployed | Completed |
| Claims Denying EXx4 for DX Z1389/Z3189/J1884 | All Providers | Claims being billed are denying EXx4 (Notice Date 7/28/23) (PDF) | Solution Deployed | Completed |
| Claims Incorrectly Paying EX94‒A Percentage of Billed Charges | All Providers | Claims Incorrectly Paying EX94‒A Percentage of Billed Charges (Notice Date 5/5/23) (PDF) | Solution Deployed | Completed |
| CPT® Codes 36470, 42900 and 36471 reimbursing at $0 in error | All Providers | CPT® Codes 36470, 42900 and 36471 reimbursing at $0 in error (Notice Date 3/8/23) (PDF) | Solution Deployed | Completed |
| HCPCS T1040 Denying EXGT | FQHC, RHC and Encounter clinics | HCPCS T1040 Denying EXGT (Notice Date 3/8/23) (PDF) | Solution Deployed | Completed |
| CPT® Code 90651Gardasil Denying Incorrectly | All Providers | CPT® Code 90651Gardasil Denying Incorrectly (Notice Date 1/13/23) (PDF) | Solution Deployed | Completed |
| Vaccine Codes Paying at Incorrect Rate | All Providers | Vaccine Codes Paying at Incorrect Rate (Notice Date 1/13/23) (PDF) | Solution Deployed | Completed |
| Laboratory Codes Denying ExIM | Laboratory Codes Denying ExIM | Laboratory Codes Denying ExIM (Notice Date 1/13/23) (PDF) | Solution Deployed | Completed |
| EAPG COVID Overpayments | All Providers | EAPG COVID Overpayments (Notice Date 1/9/2023) (PDF) | Solution Deployed | Completed |
| Therapy Codes Denying EX46 | Chiropractors | Therapy Codes Denying EX46 (Notice Date 3/8/23) (PDF) | Solution Deployed | Completed |
| Patient Credit file being applied twice | Hospice Long Term Care | Patient Credit file being applied twice (Notice Date 10/14/2022) (PDF) | Solution Deployed | Completed |
| Anesthesia Codes Denying ExZE | Anesthesia Providers | Anesthesia Codes Denying ExZE (Notice Date 1/9/23) (PDF) | Solution Deployed | Completed |
| DME- Orthotics denying EX35 | All Providers | DME- Orthotics denying EX35 (Notice Date 10/28/2022) (PDF) | Solution Deployed | Completed |
| DME Procedure Codes @100% of Billed Charges | All Providers | DME Procedure Codes @100% of Billed Charges (Notice Date 8/5/2022) (PDF) | Solution Deployed | Completed |
| DME Procedure Codes Under Paid @ 25% of Billed Charges | All Providers | DME Procedure Codes Under Paid @ 25% of Billed Charges (Notice Date 8/5/2022) (PDF) | Solution Deployed | Completed |
| Telehealth Place of Service 10-Modifier 93 | All Providers | Telehealth Place of Service 10-Modifier 93 (PDF) | Solution Deployed | Completed |
| HCPCS 0240U, 0241U, 87637 added with the QW modifier | All Providers | HCPCS 0240U, 0241U, 87637 added with the QW modifier (PDF) | Solution Deployed | Completed |
| S5130 overpaid from 1/27/22 through 2/10/22 | Waivers | S5130 overpaid from 1/27/22 through 2/10/22 (PDF) | Solution Deployed | Completed |
| A0120 and A0130 claims denying EXL6 | Transportation | A0120 and A0130 claims denying EXL6 (PDF) | Solution Deployed | Completed |
| 7/1/2020 Enhanced Practitioner Fee Schedule Rate | Physicians, Advanced Practice Nurses, Local Health Departments and Physician Assistants | 7/1/2020 Enhanced Practitioner Fee Schedule Rate (PDF) | Solution Deployed | Completed |
| A0120, A0130, T2001 and T2005 denying EXBV | Ambulance | A0120, A0130, T2001 and T2005 denying EXBV (PDF) | Solution Deployed | Completed |
| Revenue Code 657 claims denying EXBt | Hospice | Revenue Code 657 claims denying EXBt (PDF) | Solution Deployed | Completed |
| A0130 incorrectly denying for Health Choice and YouthCare | Ambulance | A0130 incorrectly denying for Health Choice and YouthCare (PDF) | Solution Deployed | Completed |
| A0130 and A0425 incorrectly denying for MMAI | Ambulance | A0130 and A0425 incorrectly denying for MMA (PDF) | Solution Deployed | Completed |
| CPT® 36416 denying EXIM - Missing or Invalid Modifier | Physicians | CPT® 36416 denying EXIM - Missing or Invalid Modifier (PDF) | Solution Deployed | Completed |
| Claims Denying for EX2b, 2C, 2c, 2E, 2f and 2G for Health Choice, Youth Care and MMAI | All Providers | Claims Denying for EX2b, 2C, 2c, 2E, 2f and 2G for Health Choice, Youth Care and MMAI (PDF) | Solution Deployed | Completed |
| CPT® codes for COVID administration denying EXGT | FQHC, RHC and Encounter clinics | CPT® codes for COVID administration denying EXGT (PDF) | Solution Deployed | Completed |
| G0299 denying EXVI | Hospice | G0299 denying EXVI (PDF) | Solution Deployed | Completed |
| C and P HCPCS denying EX46 | Facilities | C and P HCPCS denying EX46 (PDF) | Solution Deployed | Completed |
| BH claims in correctly denying EX18 | BH, CMHC | BH claims in correctly denying EX18 (PDF) | Solution Deployed | Completed |
| CPT® codes for COVID administration denying EXNT | FQHC, RHC and Encounter clinics | CPT® codes for COVID administration denying EXNT (PDF) | Solution Deployed | Completed |
| CPT® 96110 denying EXIM and EXys | Practitioners | CPT® 96110 denying EXIM and EXys (PDF) | Solution Deployed | Completed |
| CMHC codes incorrectly denying for no authorization for contracted providers | CMHC | CMHC codes incorrectly denying for no authorization for contracted providers (PDF) | Solution Deployed | Completed |
| Claims denying EXsQ | RHC | Claims denying EXsQ (PDF) | Solution Deployed | Completed |
| CPT® G2023 denying EXIM and EXys | All Providers | CPT® G2023 denying EXIM and EXys (PDF) | Solution Deployed | Completed |
| CPT® 99000 COVID Specimen denying EXys | All Providers | CPT® 99000 COVID Specimen denying EXys (PDF) | Solution Deployed | Completed |
| SMHRF Revenue Code 110 Missing $10 add on | SMHRF | SMHRF Revenue Code 110 Missing $10 add on (PDF) | Solution Deployed | Completed |
| MMAI Claims Crossover Issue | All Providers | MMAI Claims Crossover Issue (PDF) | Solution Deployed | Completed |
| CPT® codes denying EXcL | All Providers | CPT® codes denying EXcL (PDF) | Solution Deployed | Completed |
| CPT® code 99401 and E&M billed together | All Providers | CPT® code 99401 and E&M billed together (PDF) | Solution Deployed | Completed |
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