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Date:

May 2, 2019

 

Purpose:

We’d like to tell you about certain home health claims we previously rejected.

 

 

Overview:

In March, we identified an issue with Medicare Advantage home health claims. The claims had service dates in 2018 and 2019, and all were received on or after March 7, 2019, with the new value code 85 (“County Where Service Is Rendered”). In our claim status responses, we rejected the claims due to the 2018 dates of service and returned the following 277 values:

  • A7: Acknowledgement/Rejected for Invalid Information – The claim/encounter has invalid information as specified in the Status details and has been rejected.
  • 726: NUBC Value Code Amount(s)

 

We corrected the issue in our internal systems on April 29, 2019, to allow the new value code to apply to 2018 dates of service. Starting May 1, we started resubmitting electronic claims through our internal claim intake process. Therefore, providers won’t have to resubmit these claims to us.

 

Once we reprocess the claims, we’ll assign a new Aetna claim ID and return new 277CA codes. We’ll retain the vendor’s original clearinghouse trace number (2300:REF02 when REF01 = D9) and the provider’s submitted patient account number (2300:CLM01).

 

 

Action requested:

This communication is for your information.

 

 

Questions?

Please direct any general questions to the EDI Assistance Center mailbox.


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