Provider CHAMPS Denial Errors

Nature of Issue:  Inaccurate Denials (EXF6- BILLING NPI NOT REGISTERED WITH STATE  and EXF7 DENY: BILLING & RENDERING NPI NOT REGISTERED WITH STATE)

Date Identified: 6/6/2024

Dates of Service Impacted:  Processing Dates of 5/30/2024-6/12/2024 

Product Line Impacted: Medicaid

Summary of Issue: The Provider Champs Enrollment File API that feeds the claims system was down from 5/30/2024-6/12/2024. Meridian identified the issue on 6/4 and worked to hold any inaccurate denials from releasing. In total we held 116k in claims of which all have now been released to pay and of which all processed timely. We did identify roughly 3k in claims that denied incorrectly before they could be held. These claims are all being adjusted and all reprocessing for the impacted claims will be complete by 7/15/2024. Providers do not need to take any action as the system is now resolved and the adjustments are in progress. 

New Claim Submission Issue Resolution Date:  6/13/2024

Prior Claim Correction Issue Resolution Date:  7/15/2024

Any action required by the provider if applicable:  NONE-
Providers do not need to take any action as the system is now resolved and the adjustments are in progress. If you feel that you had impacted claims that have not been corrected by 7/15 please provide the claim numbers to your Provider Representative for review.