Claims Processing Alert for Kansas, Nebraska, and Western Missouri Part B Providers
Claims Processing Update - June 30, 2008
WPS would like to provide a status on the mass adjustments initiated for the erroneous PR-185 denials. The mass adjusted claims are going through the processing system as expected. We are anticipating the majority of the claims originally denied between June 9, 2008 and June 12, 2008, will move to a finalized processing location by Wednesday, July 2, 2008.
On Friday, June 27, 2008, WPS initiated an additional mass adjustment for claims denied with PR-185 with a paid date of June 13, 2008. We expect the majority of those to finalize by July 4, 2008.
If you have not received payment or another remittance advice from WPS on those claims originally denied June 9, 2008 through June 13, 2008, by July 7, 2008, please resubmit your claim(s) for payment.
Providers should watch their remittance advices for claims that begin with 48, 58, or 68, as this indicates a mass adjustment claim. WPS will perform additional mass adjustments as appropriate.
Claims Processing Update - June 23, 2008
WPS continues to be committed to the timely resolution of the processing issue that caused claims to deny between June 9, 2008 and June 13, 2008. The system issue causing the erroneous denials was resolved on Thursday, June 12, 2008. This prevented any new claims submitted on or after June 12, 2008, from denying with the PR-185. Additional PR-185 denials could have occurred beyond June 12, 2008, based on where the claims were in the processing system. Providers do not need to resubmit claims or request redeterminations on any of the claims denied with the PR-185 as mass adjustments are currently being performed on those claims.
The mass adjustment process has begun and we anticipate the first payments of these mass adjusted claims will begin going out as early as Wednesday, June 25, 2008.
Things to remember about mass adjustments:
- There is no payment floor, so the claims are released immediately after finalizing.
- Claim control numbers for mass adjustments may begin with the number 48 or 58.
- Mass adjustment claims are subject to Multi-Carrier System (MCS) edits, audits or other coverage and eligibility requirements.
Additional information on mass adjustments can be found at:
http://www.wpsmedicare.com/mac/transition/ksb_massadj.pdf 
Please note: Providers who received denials for other than the PR-185 between June 9, 2008 and June 13, 2008, those denials are correct and those claims will not be mass adjusted
Claims Processing Alert for Kansas, Nebraska, and Western Missouri Part B Providers (06/12/08)
WPS has identified a system problem causing claims processed this week between June 9, 2008, and June 13, 2008, to deny with a PR-185, rendering provider is not eligible to perform the service billed, when the claim does not have a TC modifier in the first modifier field.
WPS is working quickly to correct this and will initiate a mass adjustment early next week for all claims erroneously denied. We will disseminate additional information on this issue as appropriate.
Page Last Updated: Tuesday, 15-Jul-2008 10:38:50 CDT
