Issue Corrected: Bypass Edit 5031 for FQHC and RHC Claims, CR 39572

April 9, 2014

FQHC and RHC claims should no longer deny when only one line on the claim denies.

Below, is the original message we sent on February 21, 2014, explaining the issue that has now been corrected:

Bypass Edit 5031 for FQHC and RHC Claims, CR 39572

Currently, FQHC and RHC claims are denying when only one line on the claim denies. These claims are identified in MIHMS with edit 5031, and the Remittance Advice reflects a Claims Adjustment Reason Code of 16 (Claim/service lacks information or has submission/billing error(s) which is needed for adjudication). We are working to correct this issue. Once corrected, claims will no longer deny when only one claim line denies. We will notify you once this issue is resolved.