Copay Exemption Issue Corrected

November 14, 2012

AJ condition codes are used for claims when a service provided is copay exempt. Previously, when a claim was submitted with an AJ condition code, MIHMS flagged the member associated to that claim as being copay exempt. As a result, all subsequent claims submitted for that member was processed as copay exempt even if an AJ condition code was not present on the subsequent claim(s). This issue has now been corrected. Moving forward, providers will see copays taken from the RA where they were not before. This change was implemented on 11/01/2012.