Outpatient Crossover Claims Denying for EOB 264 – Date of Service Missing

Outpatient crossover claims denying for EOB 264 - Date of Service Missing

Providers are receiving denials on outpatient crossover claims for explanation of benefit (EOB) 264 - Date of service missing. These are claims received by the Indiana Health Coverage Programs (IHCP) directly from Medicare.

Effective July 2, 2012, based on 5010 requirements, Medicare no longer requires a date of service (DOS) at the detail level for outpatient claims when there is a single DOS identified at the header of the claim. When the claim crosses over electronically to the IHCP, the DOS is missing at the detail level, causing the claim to deny for EOB 264.

Effective August 22, 2012, system changes were made to prevent these outpatient crossover claim denials. Claims that were erroneously denied for this edit will be systematically reprocessed and begin appearing on Remittance Advice (RA) statements dated September 4, 2012. These claims can be identified with internal control numbers (ICNs) that begin with region code 80.