April 11, 2011
TrailBlazer Health Enterprises® is issuing this listserv to notify the Part A community of important updates concerning all Part A services.
New: Problem/Issue Description
Reason Codes 11701 or 11801 – Certain claims are editing with reason codes 11701 or 11801, which is causing affected claims to incorrectly Return to Provider (RTP). This is affecting Direct Data Entry (DDE) and hardcopy claims. CMS has instructed FISS to inactivate reason codes 11701 and 11801 until a system correction is installed into production May 9, 2011. This will allow claims entry and correction of RTP claims.
Updated: Problem/Issue Description
Reason Code 31742 – Claims editing with reason code 31742 and dates of service that span December 2010 and January 2011 are editing correctly and are being RTP for correction.
Update:
Claims editing with reason code 31742 when the “through” date of service is January 1, 2011, are editing incorrectly. A system correction was implemented in the April 2011 system release. The system release corrected part of the issue; however, SNF and swing bed claims billed with the default Health Insurance Prospective Payment System (HIPPS) code AAA00 (no-pay bills) are continuing to edit incorrectly. Affected claims are suspending in location SMFPL3. Providers will be advised when a resolution is implemented.
