Incarcerated Claim Denials - Resolved 11/04/24

Provider/Supplier Type(s) Impacted: All

Reason Codes: U538H

Claim Coding Impact: Not applicable.

Description of Issue: Noridian is aware of an claims processing issue with claims potentially denying for incarcerated status when the beneficiary does not have incarcerated record(s). Claims denying incorrectly with reason code U538H for "SERVICES BILLED WHILE BENEFICIARY IS INCARCERATED."

Noridian Action Required: Noridian continues to work with the shared system maintainer for a resolution.

Provider/Supplier Action Required: No action is required at this time.

Proposed Resolution/Solution: The shared systems maintainer is working to resolve the issue.

11/04/24 - Noridian initiated mass adjustments on or before 10/30/24.

10/15/24 - The incarcerated file was updated on 09/23/24. Noridian will initiate adjustments by 10/25/24. Noridian will provide another update when all mass adjustments are initiated.

09/20/24 – No updates. Noridian is monitoring the issue and will provide updates as they are available.

09/05/24 - No updates. Noridian is monitoring the issue and will provide updates as they are available.

Date Reported: 08/15/24

Date Resolved: 11/04/24

Last Updated Nov 04 , 2024