Current Issue

3/19/2019 - Resolved: Claim adjustments have been completed and will continue through the processing system.

Issue Identified: February 11, 2019

Issue: Palmetto GBA automated Jurisdiction J MolDX Local Coverage Determination (LCD) L35072 diagnosis auditing effective November 5, 2018. An issue has been identified with claim adjustments performed for these services by Palmetto GBA for services that were initially processed by the outgoing Medicare Administrative Contractor (MAC) and were prior to the MolDX LCD being implemented in the Jurisdiction J environment.

Affected denials are:

  • Services outlined in LCD L35072;
  • Adjusted claims previously processed by Cahaba GBA; and
  • Denied with claim adjustment reason code 50 (these are non-covered services because this is not deemed a medical necessity) and reason and remark code N115 (this decision was based on a Local Coverage Determination (LCD)

Provider Action:
There is no provider action necessary. Palmetto GBA will perform adjustments to affected claims and this claims payment issue will be updated when the adjustments have been completed.

Status:
3/19/2019 – Resolved:
Claim adjustments have been completed and will continue through the processing system.

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

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