Waiver Claims Denying in Error for EOB Code 1112

Waiver Claims Denying in Error for EOB Code 1112

Waiver providers have received denials for claims for explanation of benefits (EOB) code 1112 - The Care Select PMP NPI is missing from the claim. In error, waiver claims began denying for this edit code with the implementation of the new Ordering, Prescribing, and Referring (OPR) validation requirement.

Waiver providers should continue to place the Legacy Provider Identifier (LPI) of the case manager in the referring physician fields of medical claim submissions. The claims processing has been corrected, and this edit will no longer cause denials. Waiver claims that were erroneously denied for EOB code 1112 may be resubmitted for reimbursement consideration.