Provider Specialty 87 as Provider Type 64 v.s. Provider Type 40 Update
States Applicable to Alert: Northern California, Southern California, Hawaii, Nevada, Guam, Northern Mariana Islands and American Samoa
Background Information: The Outgoing Contractor (OGC) set up some Specialty 87 providers as Provider Type 40. Our system does not use this provider type with this specialty. Therefore claims were incorrectly denied.
Applies To Procedure Code(s): L7510, L8616, L8618, L8619, L8622, L8623 and L9900
Modifier(s): N/A
Remark/Reason Codes:
B7 - This provider was not certified or eligible to be paid for this procedure/service on the date of service.
MAC Action: System maintenance will be performed to correct the problem. After completion of this maintenance, a mass adjustment will be performed to pay the services denied in error. A mass adjustment was performed with 0 claims found for NCA, 22 claims for SCA and 53 claims for HI/NV.
Provider Action: No action required.
Date Reported: April 14, 2009
Date Resolved: July 20, 2009