National System Issue Inadvertently Adjusted Claims - Resolved 09/26/22

Provider/Supplier Type(s) Impacted: Not applicable

Reason Codes: Not applicable

Claim Coding Impact: 99202-99205, 99211-99215, 99324-99328, 99334- 99337, 99341-99345, 99347-99350, 99354-99355, 99495-99498, G0402, G0438, G0439, 99415, 99416

Description of Issue: CMS identified a national system issue, which may have inadvertently adjusted previously processed Part B claims with dates of service (DOS) on or after January 1, 2021. These adjustments processed on July 29 through August 2, 2022.

Noridian Action Required: See solution below.

Provider/Supplier Action Required: Most of the claims that inadvertently adjusted did not result in a change in payment; therefore, most providers were not impacted and no actions are required. If the adjustment caused a payment change or denial and you disagree with the decision, please submit an appeal.

Proposed Resolution/Solution: Claims for providers participating in the Primary Care First model are being reprocessed in some instances due to an error with a CMS Change Request for the Fee-For-Service claims processing system, which resulted in an incorrect payment. The reprocessing will ensure the provider receives the correct payment of a Flat Visit Fee rather than the Fee-For-Service fee for appropriate claims.

09/26/22 - The file has been corrected with the appropriate providers for any future adjustments.

Date Reported: 08/18/22

Date Resolved: 09/26/22


Last Updated Oct 18 , 2022