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March 3, 2017

UPDATE: Claims Processing Issue Affecting Units Field

On January 19, 2017, we informed you of an issue we detected with our claims processing system that impacted the way the “units” field on Part B claims was processed. This affected claims submitted from December 31, 2016 - January 5, 2017.

Effective immediately, no further action is required of you. We will perform mass adjustments on most claims that have not already been brought to our attention. Please allow 4-6 weeks for the mass adjustment to complete. If, after that time, your claims have not been adjusted, please contact our Provider Contact Center.

The mass adjustment will apply to any claim that includes at least ONE line that was processed as 00001 in error. Claims with additional line items submitted with 2-9 units that were incorrectly processed as 00002-00009 will also be adjusted. There is an exception for claims with additional line items billed with 10 or more units. Those claims WILL NOT be included in the mass adjustment.

Again, there are exceptions to the mass adjustment. The following exceptions WILL NOT automatically adjusted:

  • Any claim that DOES NOT have at least one line on the claim that processed as 00001 incorrectly. For example, if your claim has a single line item that was processed with a unit of 00002, it WILL NOT automatically adjusted.
  • Any claim that has a line processed with units billed of 10 or more incorrectly. For example, line one was processed as 00001 incorrectly; line 2 was billed with 11 units and processed as 00011 incorrectly.
  • Any ambulance claim.
  • Any anesthesia claim.

For claims that fall into these exceptions, please continue to following the instructions outlined in the January 19, 2017, article to initiate an adjustment.

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