Aetna - Issue with Medicare home health claims received with value code 85.
Posted by Sheila Odeen on 02 May 2019 04:54 PM
May 2, 2019
We’d like to tell you about certain home health claims we previously rejected.
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:
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).
This communication is for your information.
Please direct any general questions to the EDI Assistance Center mailbox.