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Article Detail - JF Part B

Mass Adjustments for Claims Subject to ACO Realizing, Equity, Access, and Community Health (REACH) Model Reductions - Resolved 06/22/23

Provider/Supplier Type(s) Impacted: All providers participating in the ACO REACH Model.

Reason Codes: n/a

Claim Coding Impact: G0402, G0438-G0439, G0442-G0444, G0463, G0506, G2010, G2012, G2064-G2065, G2212, G2214, G2252, G3002-G3003, 96160-96161, 99201-99205, 99211-99215, 99304-99318, 99324-99328, 99334-99337, 99339-99345, 99347-99350, 99348, 99354-99355, 99417, 99421-99423, 99424-99427, 99437, 99441-99443, 99483, 99484, 99487, 99489-99490, 99491, 99492-99498

Description of Issue: Claims for 2023 dates of service subject to the ACO REACH Model reductions were processed as normal Medicare Fee-for-Service.

Noridian Action Required: Noridian will reprocess the identified claims.

Provider/Supplier Action Required: There is no provider action.

06/22/23 - No provider action is needed to correct the claims. Providers should follow the regular process for paying any overpayments on the claims that denied in error.

Proposed Resolution/Solution: The claims were adjusted and released for processing on May 24, 2023.

Date Reported: 05/30/23

Date Resolved: 06/22/23

 

            Last Updated Mon, 24 Jul 2023 16:38:49 +0000