Skip to Main Content

Known Issues and Resolution Timeframes

Updated 07/23/2021

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 #
DME, laboratory and COVID procedure codes denying with NDC denials (PDF) All providers Full Resolution Deployed Project in process 08/31/2021 PROJ-203928102
2020 ACA Enhanced provider rate project ACA enhanced rate eligible provders Correcting processing inaccuracies Claims project re-work in process 8/6/2021 PROJ-197140078

 

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

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 EAPG Hospital (COB claims) (PDF) Facilities 1/8/2021 1/6/2021 PROJ-145680937
Multiple EAPG Hospitals (COB claims) (PDF) Facilities 10/13/2020 9/28/2020 PROJ-145660630
Multiple EAPG Hospitals – Phase 2 (PDF) Facilities 10/19/2020 9/25/2020 PROJ-146673622
Multiple EAPG Hospitals – Phase 1 (PDF) Facilities 9/30/2020 8/31/2020 PROJ-143464168
Lesser of logic applied at the line level charge not the claim total charge on EAPG outpatient claims (PDF) Facilities N/A N/A N/A
Boys Town Research EAPG underpayments Facility 9/21/2020 8/26/2020 Proj-141443705