States Applicable to Alerts: Northern and Southern California, Nevada, Hawaii, Guam, American Samoa and Northern Mariana Islands.
Background Information: Due to an incorrect system update to CPT code 95920, previously allowed provider types and specialties might have been denied. This error affected claims processed July 1, 2009, through August 19, 2009.
Modifiers: Not applicable
Remark/Reason Codes: B7 - This provider was not certified or eligible to be paid for this service.
MAC Action: The system has been updated for the J1 environments to process the provider type/specialty correctly. There were 316 claims adjusted in Southern California, 176 claims in Northern California and three in Nevada/Hawaii.
Provider Action: None
Date Reported: August 17, 2009
Date Resolved: September 15, 2009