HFSMedical ProvidersClaims Processing System IssuesNon-Emergency Transportation Claims are Denying, X73 – Missing/Invalid Prior Approval

Non-Emergency Transportation Claims are Denying, X73 – Missing/Invalid Prior Approval

HFS System Issue:

Non-emergency claims require prior approval. Claims denied whether or not they had prior approval.

Problem:

For the months of May and June, the department reduced the reimbursement rates for many providers. Even though non-emergency transportation rates are not reduced, all claims were placed on hold including transportation claims while programming changes were made. When the hold was released in the system, the system did not recognize the prior approvals in the system and claims rejected X73, missing/invalid prior approval.

Providers Impacted:

Non-emergency Transportation Providers 

Problem Begin Date:

Claims with service dates on or after 5/1/2015 were placed on hold beginning May 1, 2015.

Problem Fix Date:

Claims that were previously on hold were released May 26, 2015. Claims received after May 26, 2015 are processing correctly.

Resolution for Impacted Claims:

Claims must be rebilled. A time override will be authorized for claims if the claims were affected by this issue. All re-submitted claims, electronic and paper, must be received by the department by December 5, 2015. 

Claims not previously submitted are subject to the timely filing requirement.

 

 


Claims Processing System Issues

 

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