Claims to be re-processed

June 30, 2011

The following list describes claims that will be or have been re-processed to correct system errors. Providers do not need to re-submit these claims.

  • Behavioral Health Services code H2010. This benefit has been added for members age 18 to 20 years old.

  • Fluoride varnish. A systems issue caused claims for fluoride varnish to pay $0.

  • Member co-pays. Due to mishandling of member co-pays, some claims were over-paid and others were under-paid.

  • Procedure codes with modifier GY and QW.

  • Radiology code 77338. This code had not been included in provider contracts. (Note: hospital claims for this code will be re-processed after July 1, 2011.)

  • Vision care codes. During the week of June 20th, claims for certain vision care codes were adjusted. The adjustments used incorrect rates. These adjustments will be reversed, and the correct rates applied. Corrections will appear on Remittance Advice statements starting the week of July 4th.