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Enrollment in the Health Benefits for Immigrant Adults (HBIA) program will be temporarily paused effective July 1, 2023.

Enrollment in the Health Benefits for Immigrant Seniors (HBIS) program will be temporarily paused effective Nov. 6, 2023.

Provider Notice Issued 08/11/2020

Date::    August 11, 2020


To:       Participating Hospitals:  Chief Executive Officers; Chief Financial Officers; and Patient Accounts Managers


Re:      Repricing Hospital Outpatient Claims Billed with COVID-19 Diagnosis and Procedure Codes



This notice informs hospitals that certain outpatient claims containing COVID-19-related coding will be reprocessed. The information below applies specifically to traditional Medicaid fee-for-service claims; however, for managed care claims, the managed care plans will also identify any claims impacted by these changes and automatically reprocess them. Hospitals do not need to take any action on these claims.


Issue #1 - Outpatient Claims with Dates of Service March 1st through May 21st, 2020 Containing Diagnosis Code U07.1 and HCPCS Codes U0001, U0002, 87635, G2023, and G2024

The Department transitioned to a new EAPG grouper version on May 22, 2020. This EAPG grouper version includes new ICD-10 diagnosis code U07.1 - COVID-19, Virus Identified (effective April 1, 2020), and additional COVID-related HCPCS codes U0001, U0002, 87635, G2023, and G2024. Claims that processed through the EAPG grouper that contained any of these codes may have grouped and priced incorrectly.  


Issue #2 – Outpatient Claims with Dates of Service April 14th through June 30th, 2020 Containing HCPCS Codes U0003, U0004, 86769, and 86328

These four COVID-related HCPCS codes (all effective April 14, 2020) have not yet been added to the HFS EAPG grouper. Claims already processed with these codes for dates of service April 14, 2020 through June 30, 2020 may have grouped and priced incorrectly.


The Department has identified the affected claims from both issues above and will void and reprice them using the updated version of the EAPG grouper. The voided claims will be identified on the Remittance Advice with Adjustment Reason Code 5018 – EAPG Priced COVID Codes with EAPG 0999 at $0. The reprocessed claims will be assigned new Document Control Numbers.


Outpatient claims with dates of service beginning July 1, 2020 are currently on hold while the Department finalizes system changes. EAPG grouper updates will be completed before these claims are released, allowing them to price correctly.


Questions may be directed to the Bureau of Hospital and Provider Services at 877-782-5565, or to the applicable managed care plan.



Kelly Cunningham

Interim Medicaid Administrator