Incarcerated Claim Denials - Resolved 11/04/24

Provider/Supplier Type(s) Impacted: All

Reason Codes: Not applicable

Claim Coding Impact: Not applicable

Description of Issue: Noridian is aware of an issue with claims potentially denying for incarcerated status when the beneficiary does not have incarcerated record(s). Claims denying with CARC 258 "Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state or local authority may cover the claim/service."

Noridian Action: Noridian continues to work with the shared systems maintainer for a resolution. Claims identified will be suspended to reduce the volume of incorrect denials and the issue can be resolved.

Provider/Supplier Action Required: No action is required at this time.

Proposed Resolution/Solution: The shared systems maintainer is working to resolve the issue.

11/04/24 - Noridian initiated mass adjustments on or before 10/30/24.

10/15/24 - The incarcerated file was updated on 09/23/24. Noridian will initiate adjustments by 10/25/24. Noridian will provide another update when all mass adjustments are initiated.

09/20/24 – No updates. Noridian is monitoring the issue and will provide updates as they are available.

09/05/24 - No updates. Noridian is monitoring the issue and will provide updates as they are available.

Date Reported: 08/15/24

Date Resolved: 11/04/24

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