RESOLVED: Clinical Laboratory Claims Possibly Pricing Incorrectly on Claims With More Than 14 Claim Detail Lines


RESOLVED: Clinical Laboratory Claims Possibly Pricing Incorrectly on Claims With More Than 14 Claim Detail Lines  

Current Status

Date

 

RESOLVED 11/1/2021 Resolved: Adjustment of affected claims have been completed.
 

Status

10/12/2021

Provider Action: There is no action required for providers at this time. All impacted claims will be reprocessed. Some of the reprocessed claims could create overpayments. Processed overpayments will generate demand letters. Providers should follow the standard recoupment/repayment process identified in any overpayment letter they may receive.

Identified

10/12/2021

Issue

The MCS shared system maintainer identified two issues with some clinical laboratory service claims.

  1. Clinical laboratory claims received between July 24, 2021, and October 5, 2021, with more than nine service lines were underpaying and/or overpaying on service line 14 forward. A system fix was installed on October 4, 2021.

Note: Not all clinical laboratory claims meeting this criteria will require reprocessing, as some of the claims processed correctly.

  1. Claim Adjustments containing clinical laboratory HCPCS with more than 13 service lines began to price incorrectly on service line 14 forward. This problem fix was installed on July 24, 2021.

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Last Updated: 11/01/2021