Monday, October 28, 2013

Update to the Provider Remittance Advice Impacts as a Result of the Jurisdiction E Part B MAC Transition

Noridian has identified an impact to the content of the provider remittance advices as a result of the transition of pending workload from Palmetto Government Benefit Authorizers (PGBA) to Noridian.

Providers may notice the Glossary, Group, Reason, MOA, Remark and Adjustment Codes section of their remittance may contain verbiage that does not match the services provided.  The group codes and liability assigned to payments and denials may also be incorrect.

One example providers may notice is for claims that previously displayed CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee Arrangement) for payment.  These paid claims may incorrectly display on the remittance as a PR-150 (Payer deems the information submitted does not support this level of service).  As of 9/20/2013, this has been updated in Noridian's system. Please be aware that remittances generated on or after 09/20/13 may still show the incorrect verbiage depending on the status of the claim when the system was updated.

Noridian is currently working to correct history and provide corrected remittance advices to impacted providers.  Additional updates will be provided when they are available.

10/22/13 Update: Noridian has completed updating a large part of claims history that contained incorrect provider remittance advice messages.  We continue to work to update any remaining claims with incorrect messages.

Corrected provider remittance advices for all claims that were part of the history correction are expected to be generated in the next few weeks.  Further information regarding the dates and generation of the remittances will be provided when they are available.

Last Updated Oct 24, 2013

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