States Applicable to Alert: Hawaii, Nevada, Guam, American Samoa, Northern Mariana Islands and California
Background Information: ICD-9-CM Diagnosis Code 0600 ‘Sylvatic’ was incorrectly end dated in our system.
Remark /Reason Codes:
11 – The diagnosis is inconsistent with the procedure.
M81 – You are required to code to the highest level of specificity.
MAC Action: Some claims were rejected (not denied) during the initial mass adjustment. The search criteria for the rejected services are too broad for the volume of claims to be reprocessed and paid. Palmetto GBA will reprocess claims brought to our attention by the provider community.
Provider Action: Providers are asked to contact the Palmetto GBA J1 Part B Provider Contact Center at (866) 931-3901 with claims that need to be reprocessed.
Date Reported: March 9, 2009
Date Resolved: April 30, 2009