Known Issues and Resolution Timeframes
Updated 06/2024
If you have a claim that should be included in one of the claim projects below (which you believe denied incorrectly) and it has not yet been adjusted, please let us know the claim number so that we can research it and confirm. You may email us or contact your Provider Relations Rep.
Open Issues
Issue Description | Issue Category | Dates of Service Impacted: | Product Line Impacted: | More Information | New Claim Submission Issue Resolution Date | Prior Claim Correction Issue Resolution Date |
|---|---|---|---|---|---|---|
PI MUE Limits | Inaccurate Denial | 1/1/2023 to Current | MMP and Medicaid | TBD | TBD | |
ADJ Clinical Edit | Process Improvement | 1/1/2023 to Current | MMP and Medicaid | TBD | TBD | |
COB TF Rule | Inaccurate Denial | 1/1/2023 to Current | MMP | March 2024 via manual intervention | Reprocessing Errors Upon Request | |
Dialysis 90999 vs 90935 | Inaccurate Denial | 01/01/2023 to Current | MMP and Medicaid | 5/21/2024 | 8/1/2024 | |
MMP Crossover | Inaccurate Denial | 1/1/2023 to Current | MMP | 10/1/2024 | Resolution Ongoing (Currently Reprocessing Claims DOS April 2024) | |
Inpatient Transfer Dup Denial | Inaccurate Denial | 1/1/2023 to Current | MMP and Medicaid | 5/15/2024 | 8/1/2024 | |
| Provider CHAMPS Denial errors | Inaccurate Denial | Processing Dates of 5/30/2024-6/12/2024 | Medicaid | Provider CHAMPS Denial Errors Details | 6/13/2024 | 7/15/2024 |
| Issue Key | Issue Resolution Status |
|---|---|
| Research | Issue under investigation to determine root cause |
| Solution Identified | Issue has been identified, but no system updates (to date) have been made |
| Full Resolution Deployed | Issue has been corrected in the system and all of the system updates have been made |
| Claim Key | Claim Project Status |
|---|---|
| In Process of project creation | Project under investigation to determine affected claims and providers |
| Project in Process | Claim project has been initiated, provide payment will begin within next 7 days |
| Project Complete | Claims included in the claim project have reprocessed. Note, this is not a guarantee of payment, during reprocessing claims may hit additional claim edits |
For questions about global issues or the associated claims projects, please contact Provider Services or your Provider Relations Rep.
Special Projects in Process
| Special Project Name | Project Description | Estimated Claims Processing Date | Actual Claims Completion | Project Number |
|---|---|---|---|---|
| n/a | n/a | n/a | n/a | n/a |
Recovery Projects
Recovery notice letters to be mailed to providers within 30 days of the project being submitted, followed by a 60-day notice period, during which providers can decide if they want to mail Meridian a refund check or allow the claims to be recouped automatically at the end of the 60-day notice period.
| Recovery Project Name | Project Description | Recovery Estimated Completion Date | Notification Letters Sent | Project Number |
|---|---|---|---|---|
| n/a | n/a | n/a | n/a | n/a |
Completed Projects
Below is a listing of completed claim projects. If you have a claim that should be included in one of the completed claim projects below (which you believe denied incorrectly) and it has not yet been adjusted, please let us know the claim number so that we can research it and confirm. You may email us or contact your Provider Relations Rep.
| COMPLETED ISSUE DESCRIPTION | IMPACTED PROVIDER TYPE | IMPACTED CLAIMS SPAN | COMPLETION DATE |
|---|---|---|---|
Codes 64615 and J0588/J0585 | Medicaid | Post 4/1 DOS | 1/1/2024 |
TOB 851 Issues | Meridian Complete | Post 4/1 DOS | 1/1/2024 |
J3380 Pricing Not Available | Medicaid | POST 4/1/22 DOS FOR 2022 ONLY | 1/1/2024 |
Fractional Mileage | Medicaid | Post 4/1 DOS | 1/1/2024 |
Critical care codes w/ Mod 27 | Medicaid | POST 4/1/22 | 1/1/2024 |
ER Downcoding reprocessing paying $0 | Medicaid | POST 4/1/22 | 1/1/2024 |
G0463 Denying when billed with a treatment room Revenue Code | Medicaid | Post 4/1/22 | 1/1/2024 |
Removal of Duplicate (Exyq/yQ, EXyJ) | Medicaid | 8/24/2023 - Present | 1/1/2024 |
Removal of Leveling of ER Services CC.PP.053 Policy | Medicaid | 8/24/2023 - Present | 1/1/2024 |
Removal of Outpatient Testing for Drugs of Abuse CC.MP.50 Policy | Medicaid | 8/24/2023 - Present | 1/1/2024 |
Removal of Problem-Oriented Visits with Preventative Visits CC.PP.057 Policy | Medicaid | 8/24/2023 - Present | 1/1/2024 |
Removal of Problem-Oriented Visits with Surgical Procedures CC.PP.052 Policy | Medicaid | 8/24/2023 - Present | 1/1/2024 |
Removal of E/M Bundling with Labs and Radiology CC.PP.10 Policy | Medicaid | 8/24/2023 - Present | 1/1/2024 |
Hospice Claims Not Pricing Correctly | Medicaid | Post 4/1/2022 | 1/1/2024 |
Rev Code 637 | Medicaid | 4/1/2022 - Present | 1/1/2024 |
Code 92507 Speech Therapy hitting for Exya | Medicaid | 10/5/2023 - Present | 1/1/2024 |