Known Issues and Resolution Timeframes
If you have a claim that should be included in one of the claim projects below (which you believe denied incorrectly) and it has not yet been adjusted, please let us know the claim number so that we can research it and confirm. You may email us or contact your Provider Relations Rep.
|Open Issue Description||Impacted Provider Type||Issue Resolution Status||Claim Project Status||Target Completion Date||Claim Project #|
|Lesser of logic applied at the line level charge not the claim total charge on EAPG outpatient claims (PDF)||Facilities||Solution Identified||Project in Process||10/31/2020||n/a|
|Issue Key||Issue Resolution Status|
|Research||Issue under investigation to determine root cause|
|Solution Identified||Issue has been identified, but no system updates (to date) have been made|
|Full Resolution Deployed||Issue has been corrected in the system and all of the system updates have been made|
|Claim Key||Claim Project Status|
|In Process of project creation||Project under investigation to determine affected claims and providers|
|Project in Process||Claim project has been initiated, provide payment will begin within next 7 days|
|Project Complete||Claims included in the claim project have reprocessed. Note, this is not a guarantee of payment, during reprocessing claims may hit additional claim edits|
For questions about global issues or the associated claims projects, please contact Provider Services or your Provider Relations representative.
Special Projects in Process
|Special Project Name||Project Description||Estimated Claims Processing Date||Actual Claims Completion||Project Number|
|Multiple EAPG Hospitals – Phase 1||Lesser of logic applied at the line level charge not the claim total charge on EAPG outpatient claims||9/30/2020||n/a||PROJ-143464168|
|Boys Town Research||EAPG Underpayments||9/21/2020||n/a||PROJ-141443705|
Recovery notice letters to be mailed to providers within 30 days of the project being submitted, followed by a 60-day notice period, during which providers can decide if they want to mail Nebraska Total Care a refund check or allow the claims to be recouped automatically at the end of the 60-day notice period.
|Recovery Project Name||Project Description||Recovery Estimated Completion Date||Notification Letters Sent||Project Number|
Below is a listing of completed claim projects. If you have a claim that should be included in one of the completed claim projects below (which you believe denied incorrectly) and it has not yet been adjusted, please let us know the claim number so that we can research it and confirm. You may email us or contact your Provider Relations Rep.
|Completed Issue Description||Impacted Provider Specialty||Estimated Claims Reprocessing Date||Actual Claims Completion Date||Project Number|
|Multiple 97129 and 97130 therapy codes not paying correctly (PDF)||Therapy||9/9/2020||7/17/2020||PROJ-139690126|
|Underpayment of professional service claims (HCFA 1500 form) with NDC denials when secondary to Medicare and Medicare has identified patient responsibility||Providers billing on professional service claims (HCFA 1500 form)||n/a||n/a||n/a|
|Multiple Codes Denying EX46 (PDF)||All||9/27/2019||9/26/2019||PROJ-76675288|
|EX UZ Denials TOB 22X (PDF)||Facilities||9/13/2019||9/13/2019||PROJ-75104982|
|Member Eligibility Recoupments (PDF)||All||9/13/2019||9/12/2019||PROJ-56057584|
|Nebraska Total Care will update their claim system to require professional service claims received on CMS-1500 form for PT/OT/ST, DME, and Hearing Aids to include referring/ordering physician information on the claim||Physicians billing on CMS-1500||n/a||n/a||n/a|
|Inpatient claims processing with the EXcR denial code on service lines incorrectly with no financial impact to the paid amount||Facilities||n/a||n/a||n/a|
|Therapy Evaluation and Re-evaluation Denials (PDF)||Therapy||9/25/2019||8/14/2019||PROJ-77645498|
|UB-04 corrected claims submitted through Provider Portal converting to CMS-1500 format and denying UZ||Facilities||n/a||n/a||n/a|
|Speech Therapy Services Paying Incorrectly (PDF)||Speech Therapists||9/18/2019||7/30/2019||PROJ-76530594|