Article Detail - JE Part B
Incorrect Coinsurance Percentage Applied for Drugs and Biologicals - Resolved 03/23/22
Provider/Supplier Type(s) Impacted: All providers.
Reason Codes: Not applicable.
Claim Coding Impact: All drug and biological HCPCS.
Description of Issue: The MCS system maintainer has notified Medicare Administrative Contractors (MACs) of an issue where the copayment amount applied to drug and biological claims for any date of service finalized on or after 10/27/21, may have been applied at .2 percent instead of 20 percent.
Noridian Action Required: Noridian will publish additional information when additional details regarding a system fix and corrective actions are available.
Provider/Supplier Action Required: No provider action at this time.
03/23/22 - Providers should follow the regular process for reviewing the co-insurance and/or deductible reported on the remits for the adjusted claims.
Proposed Resolution/Solution: When the MCS shared system maintainer notifies MACs of the system fix and corrective actions needed, Noridian will provide additional information as it becomes available.
12/07/21 - MCS is continuing to work on this issue. Noridian will continue to monitor and provide updates as they become available.
12/21/21 - MCS is continuing to work on this issue. Noridian will continue to monitor and provide updates as they become available.
01/24/22 - MCS is continuing to work on this issue. Noridian will continue to monitor and provide updates as they become available.
02/10/22 - MCS updated the system. Claims are processing with the correct co-insurance as of 02/07/22. MCS is compiling a list of affected claims. Noridian will initiate mass adjustments when the claim list is available.
03/23/22 - Noridian completed mass adjustments of impacted claims on 03/21/22.
Date Reported: 11/12/21
Date Resolved: 03/23/22
Last Updated Wed, 23 Mar 2022 18:18:10 +0000