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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.

Elizabeth M. Whitehorn, Director

Non-Emergency Transportation Claims Suspended, D04, Pricing Problem

HFS System Issue:

Non-emergency transportation claims were suspended. Providers received information on the remittance advice stating the claims were suspended with code D04, pricing problem.

Problem:

Non-emergency transportation claims were suspended for department review. The system did not allow the suspended claims to be released.

Procedure Codes Impacted:

A0090, A0100, A0120, A0130, A0422, A0425, A0428, T2001

Problem Begin Date:

Claims submitted between December 27, 2012 and July 11, 2014

Problem Fix Date:

March 19, 2015

Resolution for Impacted Claims:

The claims were released and are now being denied due to various billing errors. The errors must be corrected, and the claims rebilled. Rejected claims on the remittance advice will be identified with a Document Control Number (DCN) beginning with the digits 2361 through 4190, for example "2361" on DCN: 236115123456.

Providers must resubmit claims that rejected for this issue within 180 days from the date of this posting. Providers may bill on paper or electronically. Override information has been entered into the system. If a claim rejected for this issue, it can be rebilled without a manual override.