Inappropriate Payment for Contractor Priced PET Scan Codes for Dates of Service 01/01/2020 and Forward - Resolved 09/01/21

Provider/Supplier Type(s) Impacted: All providers

Reason Codes: N/A

Claim Coding Impact: 78429, 78430, 78431, 78432, 78433, 78434, 78459, 78491 78492

Description of Issue: Noridian identified 9 PET Scan codes that were calculated incorrectly for claims processed on or after May 19, 2021 for dates of service January 20, 2020 and after. Codes 78429, 78430, 78431, 78432, 78433, 78459, 78491, and 78492 are underpaying and code 78434 is overpaying. The system is currently being updated with the correct fees for all the above-mentioned codes and a mass adjustment will be completed once the update is complete.

09/01/21 - The system has been updated with the correct fees for all the above-mentioned codes. Previously processed claims impacted by the fee error were identified and steps to reprocess those claims were initiated.

Noridian Action Required: Noridian is updating internal systems and will reprocess affected claims. The contractor price fee schedule will also be updated.

Provider/Supplier Action Required: No action is required by the providers.

Proposed Resolution/Solution: A mass adjustment will be completed, and the Contractor Fees schedule will be updated.

Date Reported: 08/03/21

Date Resolved: 09/01/21


            Last Updated Wed, 10 Nov 2021 19:12:16 +0000