Co-pay Applied Incorrectly for Some Members
July 31, 2012
Members are co-pay exempt if they have a Nursing Home or Residential Care Cost of Care (COC). They are also co-pay exempt if they have one of the following eligibility categories: - Section 19 – Home and Community Based Waiver (HCB) Elderly and Adults (coverage codes ME00033 & ME00050), - Section 21 – Developmental Services Comprehensive Waiver (coverage code ME00037), - Section 22 – HCB Physically Disabled (coverage code ME00034)
The system was incorrectly applying co-pays to claims processed for these members. DME and Transportation providers were primarily affected by this issue.
This has now been corrected and claims have been reprocessed. Providers do not need to take action at this time.