Hospital Claims Adjustments

February 14, 2012

Over the next few months, hospitals will notice an increase in the volume of claim adjustments. Claims that previously processed incorrectly due to system issues are now being re-processed.

Some examples related to these adjustments are as follows:

  • APC Claims Pricing Issue: Line items that paid at zero inappropriately for APC claims adjudicated between 9/15/10 and 11/03/10 have now been corrected.

  • Claim lines not processing or paying at zero: CPT/HCPC codes that fall under Status Indicators B and E of the Out Patient Prospective Payment System (OPPS) Addendum B have been updated to reflect appropriate rates.

  • Claims with CPT/HCPC codes that were effective in 2011 were denied in error: Hospitals experienced issues when submitting claims with new CPT/HCPC codes. Code updates for 2011 have been completed.

If there are any questions regarding this, please contact Provider Services at 1-866-690-5585.