Medical, dental, and crossover Part B claims processing inappropriately

HP has identified an issue with the claims processing system. This issue affects claims processed December 24, 25, 26, and 29, 2014. Claims may have been inappropriately paid or denied with one of the following explanation of benefit (EOB) codes. If claims were inappropriately paid or denied with other EOBs, they will be corrected as well.

  • 4184 - Claim successfully processed through NCCI editing during recycle process. Therefore, appropriate EOB's will be posted applicable to claim
  • 4185 - The claim did not process through National Correct Coding Initiative (NCCI) editing. The claim will be reprocessed or adjusted at a later date. Please monitor future Remittance Advice statements for processing activity related to this claim
  • 3001 - Service requires prior authorization

HP began reprocessing and mass adjusting claims associated with this issue December 24, 2014. Providers will see adjusted and reprocessed claims appear on Remittance Advices (RAs) dated January 6 and January 13, 2015.