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Known Issues and Resolution Timeframes

Updated 7/31/2020

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 Issues

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 Projects

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
n/a n/a n/a n/a n/a

Completed Projects

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