Provider/Supplier Type(s) Impacted: Outpatient 13X TOB

Reason Codes: 39621, C5462

Claim Coding Impact: HCPCS codes subject to Prior Authorization

Description of Issue: There is a system issue returning claims with a Prior Authorization Unique Tracking Number (UTN) in error. The issue is with Reason Code (RC) 39621, but claims with RC C5462 are impacted. Noridian is holding claims with RC C5462. C5462 is an appropriate denial, but RC 39621 prevents the denial from processing. There may be additional claims that edit with RC 39621 and return to the provider (RTP) in error.

Noridian Action Required: When the issue is resolved, Noridian will release the RC C5462 claim hold and recycle the claims with RC 39621. Claims that edited appropriately with RC 39621 will return to RTP status.

Provider/Supplier Action Required: No action is required. If the claim is subject to prior authorization, do not remove the UTN and do not suppress the claims.

Proposed Resolution/Solution: The Shared System Maintainer, FISS, is working on the issue. The expected resolution date is 11/01/21.

11/01/21 - Noridian is continuing to work with the Shared System Maintainer on a resolution.

12/08/21 - FISS updated the shared system, and Noridian is working on releasing the impacted claims.

01/05/22 - The claims have been released for further processing. There is a remaining issue when lines related to a prior authorization program are denied and there are other paid charges on the claim.

Noridian will continue to work with the shared system to determine a solution.

01/24/22 - Noridian is continuing to work with the shared system to determine a solution.

02/09/22 - FISS identified a solution, and Noridian is working on releasing the remaining claims.

02/17/22 - Claims are released for further processing.

Date Reported: 09/22/21

Date Resolved: 02/17/22