Provider/Supplier Type(s) Impacted: ESRD 72X Type of Bill in California only

Reason Codes: Not applicable

Claim Coding Impact: A4657

Description of Issue: Noridian identified an issue with the rates for A4657 not populating, which impacts the calculation of claim payments. The issue only impacts California claims for the following Carrier/Localities: 01112/51-70 and 75, and 01182/71-74. Only claims that resulted in payment errors will be adjusted.

Noridian Action Required: Noridian is reprocessing impacted claims for dates of service 02/01/18 through 12/09/20.

05/27/21 - Mass adjustments are initiated.

06/04/21 - Noridian identified additional claims that were not adjusted with the initial mass adjustment. Noridian will be adjusting the remaining claims.

07/13/21 - The additional claims were adjusted.

Provider/Supplier Action Required: No action required.

Proposed Resolution/Solution: Noridian is mass adjusting claims.

Date Reported: 04/21/21

Date Resolved: 07/13/21