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Elizabeth M. Whitehorn, Director

Error Code X11

HFS System Issue:

Preventive visit codes billed within the maximum time limit of another preventive visit were denied Error Code X11, Procedure Conflicts with Program Limits.

Problem:

The department’s coding system for preventive visit codes was previously changed in response to audit findings and the limits were set as follows:

  • For children birth through 2 years, the number of preventive visits allowed followed the periodicity schedule found in Topic HK-203.1.1 of the Healthy Kids Handbook.

  • For individuals age 3 and older, including adults, one preventive visit per year was allowed

The change inadvertently caused claims to deny.

Providers Impacted:

Physicians, Clinics, APNs, FQHCs, RHCs, ERCs, Health Departments

Procedure Codes Impacted:

All preventive services within the procedure code range of 99381-99397.

Problem Begin Date:

Claims received on or after 11/1/2012.

Problem Fix Date:

9/15/2014

Resolution for Impacted Claims:

HFS recognizes that preventive visits may be required in excess of the recommended limits. The department has modified the system limits for preventive visit codes. Providers must re-bill the department. A time override has been systematically authorized for claims resubmitted electronically, provided they match the claims that previously rejected X11 on preventive visit codes and the dates of service are between 11/01/2012 and 09/15/2014. Claims that are rebilled on the paper HFS 2360 will require manual overrides. Instructions for the paper override process are explained in detail on the department’s Non-Institutional Providers Resources webpage. All re-submitted claims, electronic and paper, must be received by the department between 11/10/14 and 05/14/2015.