RESOLVED: UPIC/ZPIC Edits on Home Health Final Claims and Requests for Anticipated Payment (RAPs)

Current Status
10/18/18: Palmetto GBA has re-entered the denied RAPs for processing and the final (end of episode) claims have been adjusted. Please check DDE or your remittance advices for status of the adjusted claims and re-entered RAPs.

Situation:
Some home health agencies may have had final (end of episode) claims suspended in processing location S B6000 with reason code (RC) 5Z7BS. In addition, Requests for Anticipated Payments (RAPs) may have received line denials with RC 5Z74H. These RCs would normally identify SafeGuard Services (SGS), the Southeastern Unified Program Integrity Contractor UPIC is conducting edits.

Palmetto GBA has released* all the final claims that incorrectly suspended in processing location S B6000 to allow normal processing. RAPs that have finalized with RC 5Z74H will be reprocessed* by Palmetto GBA.

*HHAs in states within SGS’ jurisdiction may have correctly received these edits and if the claim goes into processing location S B6001, you should comply with the Additional Documentation Request (ADR).

Status:
10/18/18: Palmetto GBA has re-entered the denied RAPs for processing and the final (end of episode) claims have been adjusted. Please check DDE or your remittance advices for status of the adjusted claims and re-entered RAPs.

9/5/18: Palmetto GBA has identified RAPs that have not finalized due to this issue. We are currently in the process of correcting and reprocessing these for providers. No provider action is needed at this time. Palmetto GBA expects this process to be completed within 10 business days.

7/31/18: Palmetto GBA has re-entered the denied RAPs for processing and the final (end of episode) claims have been adjusted. Please check DDE or your remittance advices for status of the adjusted claims and re-entered RAPs.

7/16/2018: As part of the process to correct the denied RAPs, they were required to be canceled first. Now that they are canceled, Palmetto GBA is beginning to enter the new RAPs for processing. We will provide another update when all RAPs are reentered.

06/28/2018: Palmetto GBA has adjusted approximately 12,000 of the 30,000 claims that were affected by this issue. Systematically we must finalize the RAP first and then once this is complete we can adjust the final claim to process to pay as billed. We appreciate your patience as we fix this issue. No additional provider action is required.

06/20/2018: Palmetto GBA is pulling a report of the affected claims and expect adjustments to be completed in 10 business days. No provider action is required.

6/14/2018: In addition to RAPs, final claims have denied with RC 5Z74H. For claims that erroneously denied for this edit, Palmetto GBA will reprocess the claims and remove the UPIC edit. For correctly denied claims within the states within SGS’ southeastern jurisdiction that denied for the edit, you will need to appeal the determination. If you are in the southeastern jurisdiction and if you need additional assistance, the RC narrative states to contact SG

06/12/2018: Palmetto GBA will update this article when the affected RAPs have been adjusted. No additional provider action is required at this time.

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