Claims pended for edit 966

April 6, 2012

Some providers may notice an increase in the number of claims that have pended for edit 966 which requires a primary carrier paid date entered on all Coordination of Benefits (COB) claims. This rule is being applied to all COB claims even when the service is not typically covered by Medicare or other commercial carriers. This will be corrected in the system.

In the meantime, the pended claims are sorted into two groups:
- NO DATE REQUIRED (excluded/exempt services): Until the system is corrected, these claims will be processed through an automated review that may cause up to a week’s delay to finish the full adjudication process that do not ‘PEND” for other unrelated edit reasons will get picked up on next financial cycle. This group is expected to account for the majority of claims pended for this edit. No provider action is necessary.

  • DATE REQUIRED: These claims will be reviewed by staff to verify the dates on the claims. These claims on a first come, first served method. Providers should include the Explanation of Benefits (EOB) paid date with claims:
  • Include or add the “Paid Date” on the Coordination of Benefits, Direct Data Entry (DDE) screen in the claims submission area of the Health PAS Online Portal.
  • Include an EOB with the paid date with paper claims.
  • Add the “Paid Date” to the appropriate loop and segment for an 837 claim file.

If you have any questions about these changes, please contact Provider Services at 1-866-690-5585.