ESRD Treatment Choices (ETC) Model Mass Adjustments

Provider/Supplier Type(s) Impacted: ESRD/TOB 72X

Reason Codes: n/a

Claim Coding Impact: HCPCS codes 90935 thru 90999

Description of Issue: ESRD Claims paid with dates of service (DOS) on or after 01/01/22 and received on or before 09/27/24 with dialysis revenue code 0821, 0831, 0841, 0851, or 0881; a HCPCS code in the range of 90935 thru 90999; and demo code 94 are going to be adjusted due to incorrect payments. These claims had originally resulted in an overpayment.

Noridian Action Required: Noridian will reprocess the identified claims.

Provider/Supplier Action Required: No provider action is needed to correct the claims. Providers should follow the regular process for paying any overpayments on the claims that denied in error.

Proposed Resolution/Solution: The adjustments will begin the week of 01/27/25.

01/29/25 - Noridian started work on adjustments. Adjustments will be initiated in the next few weeks.

Date Reported: 01/24/25

Date Resolved:

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