Denials for U0002QW and 87635QW - Resolved 06/09/21

Provider/Supplier Type(s) Impacted: Clinical Laboratory Improvement Amendment (CLIA) waived laboratory providers.

Reason Codes: Not applicable

Claim Coding Impact: U0002QW and 87635QW

Description of Issue: An issue was identified for claims billed with HCPCS Codes U0002QW or 87635QW for dates of service on/after 03/20/20. Claims processed on/after 05/05/20 may be receiving incorrect denials stating the provider was not certified/eligible to be paid for this procedure/service. The remark codes that will appear on the remit are CO-B7 and N570.

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

05/27/21 - Adjustments will begin the week of 05/31/21.

06/09/21 - Mass adjustments were initiated on 06/01/21.

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

Proposed Resolution/Solution: The Common Working File (CWF) is implementing a correction to its programming, effective 05/10/21, to allow the QW modifier to be billed with HCPCS Codes U0002 and 87635.  Noridian will identify and adjust any claims that may have denied incorrectly stating the provider was not eligible to perform the service.  No action is needed from the provider.

Date Reported: 05/11/21

Date Resolved: 06/09/21


            Last Updated Wed, 10 Nov 2021 19:17:20 +0000