Article Detail - JF Part A
Overpaid ESRD Claims Processed 09/29/23 and 09/30/23 - Resolved 12/01/23
Provider/Supplier Type(s) Impacted: ESRD
Reason Codes: 37551
Claim Coding Impact: Not applicable.
Description of Issue: CMS reported ESRD claims were not being paid through the Pricer on 09/29/23 and 09/30/23, causing large overpayments. Claims that calculated a payment above the $50,000 threshold received reason code 37551. Claims that overpaid and did not hit the threshold were allowed to process to completion. Claims will be identified and adjusted.
Noridian Action Required: Noridian will provide updates as they are available.
Provider/Supplier Action Required: No provider action is needed to correct the claims. Providers should follow the regular process for paying any overpayments on the claims that processed in error.
12/01/23 – If a provider identifies claims that require further assistance from Noridian, please contact the Provider Contact Center.
Proposed Resolution/Solution: Claims will be identified and adjusted.
11/14/23 - Noridian will provide more information when the adjustment schedule is received from the Shared System Maintainer (FISS).
11/28/23 - Noridian will provide more information when the adjustment schedule is received from the Shared System Maintainer (FISS).
12/01/23 – Noridian did not identify claims that qualified for mass adjustment, so no adjustment is required.
Date Reported: 10/30/23
Date Resolved: 12/01/23
