Realizing Equity, Access, And Community Health (REACH) Demonstration Model Erroneous Overpayment or Refund Requests

Provider/Supplier Type(s) Impacted: Providers participating in the ACO REACH Demonstration Model

Reason Codes: Not applicable

Claim Coding Impact: Not applicable

Description of Issue: MACs were made aware of a data loading error in the Medicare Part B system maintainer cycle on July 26, 2024. This error adjusted specific claims with Dates of Service from 2021 through 2024 to either pay or deny in error. For claims paid in error, demand letters were distributed. The claims were then offset with Financial Control Numbers (FCNs) prefaced with "PI". For claims that denied in error, payments were re-issued on September 30, 2024, as an authorized return.  CMS provided education on the CMS MLN Newsletter 9/19/24: https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-09-19-mlnc#_Toc177552995.

Noridian Action Required: Noridian identified all claims affected by this error and is currently working towards a resolution.

Provider/Supplier Action Required: There is no provider action needed. Please do not submit an appeal nor a reopening on the overpayment requests.

Proposed Resolution/Solution: The resolution will be broken into two phases. Phase one includes a balancing of funds and phase two includes restoring the adjusted claims back to original status. Noridian is currently in phase one. We have started to issue refunds to those who received overpayments requests in error. Those payments will be identified with the Provider Level Balance (PLB) Reason Code 72 on the remittance advice. There is no ETA on phase two.

Date Reported: 09/18/24

Date Resolved:

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