Noridian denies 300,000 claims for E&M services in error

August 29, 2014
Area(s) of Interest: Payor Issues and Reimbursement Practice Management Public Payors 

Last fall, the Centers for Medicare and Medicaid Services experienced some editing issues with new patient evaluation and management (E&M) codes that resulted in incorrect claim denials. These issues began in October 2013, and were thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be denied incorrectly through July 15, 2014.

In January, Noridian, California's Medicare contractor, began reprocessing claims that had been denied in error and correcting those subjected to overpayment recovery. Unfortunately, while implementing the corrections, Noridian inadvertently applied the edit to established patient E&M codes 99211-99215, again resulting in incorrect denials

Noridian has corrected the editing for both the new patient codes and the established patient codes, and claims received by Noridian on and after July 16, 2014, should be processed correctly.

Noridian estimates that about 300,000 claims were denied in error, dating back to October 2013, and is now working on reprocessing all affected claims. It expects to complete the reprocessing project around the end of September.

Physicians do not need to resubmit the claims to Noridian. The claims will be automatically adjusted.

For more information, see Noridian's July 22 notice on this issue.


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