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Elizabeth M. Whitehorn, Director

Duplicate Co-Pay Messages on Paper Remittance Advice

HFS System Issue:

Certain services are assessed a co-pay. Co-pay deductions are reported with an informational comment on the HFS paper remittance advice.

Problem:

For the months of May and June, all claims entering the system began editing but, before final adjudication, were placed on hold while rate reduction programming changes were made. When the hold was released in the system, claims were re-edited and a second co-pay informational message was generated.

Providers Impacted:

Any provider billing services subject to co-pays.

Problem Begin Date:

Claims with service dates on or after 5/1/2015 were placed on hold beginning May 1, 2015.

Problem Fix Date:

Claims that were previously on hold were released May 26, 2015. Claims received after May 26, 2015 are processing correctly.

Resolution for Impacted Claims:

No action is required. Claims processed correctly; although the co-pay message appears twice on the remittance advice, only one co-payment was deducted.