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PCCM Claims Reprocessing
November 8, 2011
PCCM claims were denied incorrectly for
Edit 330 – Invalid Diagnosis Code for Benefit. The denial reason code on the Remittance Advice is M64 (Missing/incomplete/invalid other diagnosis).
Edit 271 – Benefit Restriction Group Validation Failed. The denial reason code on the Remittance Advice is B5 (Coverage/program guidelines were not met or were exceeded).
Edit 152 – Payment is denied when performed/billed by this type of provider. The denial reason code on the Remittance Advice is N95 (this provider type/provider specialty may not bill this service).
A correction has been made, and reprocessing will start mid-November. In the first week, a portion of the claims will be re-processed and monitored. We anticipate that the remaining claims affected will be re-processed by the end of November.
