Agencies
Services
DHS/DMH and SASS Claims Submitted
HFS System Issue:
DHS/DMH and SASS claims submitted by Community Mental Health Centers are either paying incorrectly or rejecting with the A59 - Procedure/Modifier/POS Combination Invalid - error code.
Additionally, some DHS/DMH claims submitted by Community Mental Health Centers for FY’17 dates of service are receiving the D04 - Suspended for Department Review - error code. This is an informational only error message and claims will continue to process and adjudicate once the hold edit is lifted.
Problem:
The Department is working to implement coding and system modifications, causing claims to either pay incorrectly or reject in error. The DHS/DMH claims receiving the D04 informational error message are being held pending implementation of contractual funding information, as well as implementation of coding and system modifications.
Providers Impacted:
Community Mental Health Centers enrolled as provider type 036.
Procedure Codes Impacted:
Problem Begin Date:
Incorrect payments or A59 rejections - July 2016
D04/Suspended for Department Review – July 1, 2016 for FY’17 claims with dates of service on or after 7/1/16
Problem Fix Date:
A59 rejection or incorrect payment – September 1, 2016.
D04 – contractual funding information was loaded on September 29, 2016. All held claims were released into processing for re-editing and final adjudication on September 30, 2016.
Resolution for Impacted Claims:
Claims that paid incorrectly will be reprocessed by the Department. Providers must resubmit claims that rejected A59.
Claims with FY’17 dates of service for which providers received the D04/’Suspended for Department Review’ informational message were released into processing for re-editing. Providers will receive remittance advice showing claim status following final adjudication. Providers do not need to resubmit unless claims require correction and resubmission due to errors received during final adjudication.