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Claims Processing System Issues 

HFS is experiencing the following system problems. Once the system problems have been resolved, we will notify the providers by updating this Web site.

If your question is not answered by the HFS Claims Processing System Issues informational pages, please send your question to us via: E-mail HFS Claims Processing System Issues.

The links below will provide you with the most current system issues that the department is experiencing as well as information regarding resolutions.

HFS System Issue

HFS System Issue Problem Begin Problem Fix Date    
Adjustments were over-recouped. First recoupment: Vouchers generated April 27, 2015, identified by Voucher Number beginning with numbers 5117.
Second recoupment: Vouchers generated April 28, 2015, identified by Voucher Number beginning with numbers 5118.
Claims for Screening, Assessment and Support Services (SASS) were processed incorrectly.
Updated July 30, 2015
The issue began with claims received on and after November 5, 2014 May 7, 2015
Certain services are assessed a co-pay. Co-pay deductions are reported with an informational comment on the HFS paper remittance advice. Claims with dates on or after May 1, 2015 were placed on hold beginning May 1, 2015. Claims that were previously on hold were released May 26, 2015. Claims received after May 26, 2015 are processing correctly.    
Non-emergency claims require prior approval. Claims denied whether or not they had prior approval. Claims with service dates on or after May 1, 2015 were placed on hold beginning May 1, 2015. Claims that were previously on hold were released May 26, 2015. Claims received after May 26, 2015 are processing correctly. 
Non-emergency transportation claims that were previously suspended with code D04, rejected G55, 180-Day Timely Filing Limit, when they were rebilled. HFS posted a webpage on April, 27, 2015 stating the claims would be rebilled, and they would bypass the timely filing edit for error code, G55, 180-day timely filing. See System Issue Page, Non Emergency Transportation Claims Suspended, D04, Pricing Problem. Claims rebilled on and after April 27, 2015. The claims affected were previously submitted between December 27, 2012 and July 11, 2014. May 20, 2015
Non-Emergency transportation claims were suspended. Providers received information on the remittance advice stating the claims were suspended with code D04, pricing problem. Claims submitted between December 27, 2012 and July 11, 2014 March 19, 2015
Oxygen procedure codes should be reimbursed at a monthly flat rate. See Provider Notice dated September 27, 2012, Oxygen Reimbursement Changes Effective December 1, 2012. Claims received for dates of service after 12/01/2012 To be announced. Continue to monitor this page for system fix updates.
Podiatric claims denying G51, Podiatric Service Inappropriate for Diagnosis Claims received on or after 10/1/2014. - 11/06/2014 for claims with dates of service on/after 10/1/2014
- 12/23/2014 for claims with dates of service prior to 10/1/2014
Update January 21, 2015 - Overpayment of Transportation Claims (A0120, A0130, A0422, A0426, AO428 and T2005) Claims received:  12/04/12 Claims received:  03/05/13
Preventive Visit Claims Denied with Error Code X11 - Procedure Conflicts with Program Limits. Claims received on or after 11/1/2012. 9/15/2014
Home Health Claims with dates of service on or after 07/01/14 are temporarily placed on hold. At this time, the Department is requesting providers who bill for In-Home Shift Hourly Nursing Services do not submit claims to the Department for dates of service on or after July 1, 2014. Claims with dates of service on or after 07/01/14 August 25, 2014
D17 Quantity Billed Requires Prior Approval Claims received on or after 9/11/14. 10/1/14
Copayments may be taken incorrectly for office visits when billed for Family Planning Services. October 1, 2014 To be announced.
T4521 is denying R09, Requires Prior Approval, inappropriately. Claims with dates of service on or about 7/21/14 August 4, 2014
MEDI Affecting Medicare Crossovers June 3, 2014 Claims submitted through MEDI after June 26, 2014, 4:07 p.m.
Ambulance Rate Changes Update – Second Batch Claims with dates of service on or after 07/01/13 Claims received on and after April 9, 2014 for dates of service on or after 7/1/13
Ambulance Rate Changes Claims with dates of service on or after 07/01/13 Claims received on and after April 9, 2014 for dates of service on or after 7/1/13
The 340B dispensing fee add-on is not being applied to claims submitted by Provider Type 52, Local Health Department. Claims received 02/04/2014 and after May 23, 2014
Local Health Department claims rejecting incorrectly for G61, Service Not Covered Without Modifier. June 9, 2014 August 5, 2014
SMART Act Ambulance Services Claims with dates of service on or after 07/01/13 Claims received on and after April 9, 2014 for dates of service on or after 7/1/13
The 340B dispensing fee add-on is not being applied to claims submitted by Provider Type 52, Local Health Department Claims received 02/04/2014 and after May 23, 2014
Copayments were being applied incorrectly for the new ACA adult population January 1, 2014 April 14, 2014
Copayments were being taken on services rendered to pregnant women July 16, 2012 April 29, 2014
SMART Act 2.7% reimbursement rate reduction no longer applies to ambulance services Claims Received: July 1, 2013 April 9, 2014
Expansion of Telehealth Services – Payment of the Q3014 Telehealth Originating Site Fee to Community Mental Health Providers for SASS eligible participants Claims received: January 29, 2010 March 25, 2014
Recoupment of Affordable Care Act (ACA) Primary Care Increased Payments January 1, 2013 November 18, 2013
Potential Overpayment of Transportation Claims (A0120, A0130, A0422, A0426, AO428 and T2005) Claims received: December 04, 2012 Claims received: March 05, 2013
Expansion of Telehealth Services – Added Telehealth Originating Site Facility Fee (Q3014) to Medicaid/MCD benefits package for Medicaid eligible DMH clients receiving distant site physician services via telemedicine Bill date: July 1, 2011 Bill date: December 16, 2013