HFSMedical ProvidersClaims Processing System IssuesDHS/DMH and SASS Claims Submitted

DHS/DMH and SASS Claims Submitted

HFS System Issue:

DHS/DMH and SASS claims submitted by Community Mental Health Centers are either paying incorrectly or rejecting with the A59 - Procedure/Modifier/POS Combination Invalid - error code.
Additionally, some DHS/DMH claims submitted by Community Mental Health Centers for FY’17 dates of service are receiving the D04 - Suspended for Department Review - error code.  This is an informational only error message and claims will continue to process and adjudicate once the hold edit is lifted.

Problem:

The Department is working to implement coding and system modifications, causing claims to either pay incorrectly or reject in error.  The DHS/DMH claims receiving the D04 informational error message are being held pending implementation of contractual funding information, as well as implementation of coding and system modifications.

Providers Impacted:

Community Mental Health Centers enrolled as provider type 036.


Procedure Codes Impacted:

All

Problem Begin Date:

Incorrect payments or A59 rejections - July 2016
D04/Suspended for Department Review – July 1, 2016 for FY’17 claims with dates of service on or after 7/1/16

Problem Fix Date:

A59 rejection or incorrect payment – September 1, 2016.
D04 – contractual funding information was loaded on September 29, 2016.  All held claims were released into processing for re-editing and final adjudication on September 30, 2016.

Resolution for Impacted Claims:

Claims that paid incorrectly will be reprocessed by the Department.  Providers must resubmit claims that rejected A59.
Claims with FY’17 dates of service for which providers received the D04/’Suspended for Department Review’ informational message were released into processing for re-editing.  Providers will receive remittance advice showing claim status following final adjudication.  Providers do not need to resubmit unless claims require correction and resubmission due to errors received during final adjudication.
 

Claims Processing System Issues

 

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