Part B Coordination of Benefits Crossover Issue
UPDATE 07/25/2014 @ 3:27 PM:
Novitas has completed additional analysis on this issue. The Part B claims that contained certain non-payable measurement codes which also contained other payable services did actually cross over to the COBC. The claims with the payable services were received and accepted by the COBC and sent to the appropriate supplemental insurers for processing.
The non-payable measurement services which contained the dash (-) in the standard message field and where the ERA showed OA 121 were also accepted by the COBC but did not contain sufficient information for the supplemental insurers to make a determination on responsibility/liability for the non-payable measurement code service. Although there should not be a change in payment, Novitas will be performing adjustments on these claims to correct the system outputs. No action is required by providers at this time.
Original Issue 07/11/2014:
Due to a system error, Part B claims containing certain non-payable measurement codes were not being crossed over to the Coordination of Benefits Contractor (COBC). Although the measurement codes are non-payable, if the claim contained a non-payable measurement code and another payable service, the system error prevented the entire claim from being crossed over to the COBC. In these situations, the provider remittance shows a message that the claim was crossed over to the COBC, however, the system error prevented the claim from being accepted by the COBC. In addition, the system error may have caused the paper remittance to show a dash (-) in the standard message field, and the ERA may show qualifier OA and message 121 for the impacted services. The system error impacted claims finalizing between July 1 and July 10. Novitas is currently identifying all claims that were impacted by this error, and will perform adjustments on the claims to correct the system error and the corrected claims will be sent to the COBC for further processing. We will update this notice as we work through the adjustment process. We apologize for any inconvenience this has caused. No action is necessary at this time by providers.
Paper Billers – CMS 1500 Claim Form Issue
UPDATE 7/25/14 @ 3:27PM:
The universe of OCR claims related to this issue has been identified. Novitas will start recoupments of all identified claims starting the week of 07/28/14. We appreciate your patience as we complete the last phase of the project.
Original Issue 06/05/2014:
A system issue for paper billers has been identified. During the Optical Character Recognition (OCR) scanning process, certain data from the providers’ CMS 1500 claim form is being populated incorrectly into the Part B processing system. For example, a mapping issue is causing an incorrect amount to be loaded to the beneficiary paid amount field (block 29 on the claim form). This may cause incorrect payments to the provider as well as the beneficiary. Novitas is working on identifying the claims and will make the appropriate adjustments. We apologize for any inconvenience this may cause. No action is necessary at this time by providers.