96372 Denying Incorrectly Requiring JA or JB Modifier - Resolved 07/23/21

Provider/Supplier Type(s) Impacted: All provider types

Claim Coding Impact: 96372

Description of Issue: An issue was identified for claims billed with code 96372 for dates of service on/after 04/01/21. Claims processed between 05/19/21 and 06/07/21 may have received incorrect denials stating the claim/service lacks information or has submission/billing errors, requiring the JA (intravenous administration) or JB (subcutaneous administration) modifier regardless of what drug was billed. The JA or JB modifier is only required when the 96372 is billed with drug J0129 and J2354. The remark codes that will appear is CO-16, M51, and N56

Noridian Action Required: Noridian will adjust any claims that were impacted and provide updates as they are available.

06/07/21 - System Updated

06/24/21 - Mass adjustment initiated

07/01/21 - Mass adjustment completed

07/20/21 - 2nd Mass Adjustment Initiated

07/23/21 - 2nd Mass Adjustment Completed

Provider/Supplier Action Required: No provider action is needed.

Proposed Resolution/Solution: The claims processing system was updated. Noridian completed mass adjustments for claims denied incorrectly.

Date Reported: 07/07/21

Date Resolved: 07/23/21


            Last Updated Wed, 10 Nov 2021 19:15:03 +0000