Update: Missing Dates of Service on Outpatient Crossover Claims

Update: Missing Dates of Service on Outpatient Crossover Claims

The Indiana Health Coverage Programs (IHCP) banner page BR201235, published August 28, 2012, included information regarding outpatient crossover claim denials for explanation of benefit (EOB) 264 - Date of service missing. These claims are received by the IHCP directly from Medicare, where the date of service (DOS) at the detail level is no longer required. 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.

The article in BR201235 noted that system changes had been made to prevent these outpatient crossover claim denials effective August 22, 2012, and that claims would systematically reprocess. It was subsequently discovered, however, that additional system changes were needed for the claims to process and price correctly. This error has caused a delay in reprocessing claims that were denied for edit 264. The systematic reprocessing will now begin appearing on Remittance Advice (RA) statements dated September 18, 2012. These claims can be identified with internal control numbers (ICNs) that begin with region code 80.

In addition, claims that were reprocessed during the period of August 22, 2012, through August 24, 2012, will be systematically mass adjusted due to the pricing concerns noted on paid claims. The systematic mass adjustment will begin appearing on RA statements dated September 25, 2012. These claims can be identified with ICNs that begin with region code 56.