Here is an update on what we have learned after week 1 of claims re-adjudication.

 

The remittances were processed without many problems. Some customers experienced R1 errors which were fixed with an update to the latest version of the IMA remittance program.

 

After processing the remittance, customers were able to successfully add the claims to the IMA grouper and check for exceptions and adjustments. 

 

Customers were able to successfully add services to these claims and send adjustment to Medicaid for second and third services received on the same day as the primary service.

 

There were a number of new issues encountered: 

 

1. CPT codes: Claims were paid based on the CPT codes used at the time of billing in 2010. Some customers did not remember what had been used and requested the ability to review and send adjustments to Medicaid when necessary.

 

2. Crisis visits with number of units:  Some customers report that crisis visits were paid for a single unit and not for multiple units (even when the visits were of longer durations). They requested the ability to review and possibly send adjustments for these as well.

3. After hours, Crisis and Collateral visits: When multiple payment were received for same day services (i.e. Crisis, Collateral, or After-hours). Only ONE of the payments were re-adjudicated. Two things need to now be done for these services
   a. The pre-APG payments for the secondary services need to be voided
   b. The re-adjudicated claim needs to be adjusted to add these services into it.

We are now working on an enhanced tool within the grouper to give you the control to address all these issues. We hope to have something ready within a week.

Stay tuned!

Please contact the helpdesk if you have further questions or if you would like to schedule some consulting time to help with this process.