Attn: Nursing Home Providers
August 2, 2013
Claims that are submitted using occurrence code 74 (non-covered level of care or LOA), 22 (date active care ended), or A3 (benefits exhausted, payer A), and denied for MIHMS edit 216 (no COB entered with secondary enrollment), or 252 (Pend claim if COB is 0 on secondary enrollment claim), are denying in error. We are working to resolve this issue. Affected claims are being reprocessed now and will be included in this week’s payment cycle. No additional claims will be affected by this issue.
Remittance Advice codes used to identify these claims are as follows:
- Remittance Advice Remark Code – MA04 (Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.)
- Claims Adjustment Reason Code – 22 (This care may be covered by another payer per coordination of benefits.)