Claims to be reprocessed

November 8, 2011

The following claims were handled incorrectly and will be reprocessed. Providers do not need to resubmit these.

  • Claims for Temporal Mandibular Joint (TMJ) care were denied incorrectly for lacking Prior Authorization. Codes include:

  • 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21172, 21179, 21180, 21181, 21182, 21183, 21184, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21208, 21209, 21210, 21215, 21230, 21235

  • Claims for procedure code A6549 were denied incorrectly for MaineCare members who also have Medicare.

  • System-initiated claim adjustments were denied incorrectly for being past the timely filing deadline.