Claim denials related to "no active provider contract"

March 30, 2012

Some providers may have received denials on claims with the denial reason “No active provider contract.” Research of these claims shows that the system did not pick up the member’s eligibility. This denial reason was issued because the claim could not find a member’s eligibility so it couldn’t pull the provider contract for payment.

We are working to find the cause of this issue. In the meantime, we will manually work these claims. We will also plan to reprocess those claims that denied inappropriately. We will provide a timeframe for the reprocessing as soon as it is known.