Medicare Inpatient claims that denied from 03/10/23 through 04/28/23

Medicare inpatient claims processing error

An edit was put into place on March 10, 2023, that is impacting Medicare Advantage, GRS, Medicare‑Medicaid Plan, and D-SNP inpatient claims received since March 10, 2023, with a date of service after October 1, 2022. The edit is being incorrectly applied for missing a surgical CPT^® code when an inpatient claim is billed with an operating room revenue code. An impact report has been developed, and we are working to identifying all claims that have been denied improperly.

When will the issue be resolved?

An adjustment project began on April 28, 2023, and is expected to be completed May 26, 2023. Note: All standard processing edits will apply to claims after the edit placed in error is removed.

All claims released as of April 28, 2023, will not be impacted by this edit and will adjudicate correctly.

What do I need to do?

No action is required from providers. All impacted claims will be readjudicated correctly.