| Issue ID | Issue | No. of Impacted Providers | Date Issue Found | No. of Days Outstanding | Estimated Fix Date | Interest Penalties Owed | Date Resolved | Status Name | Provider Type Names | Category Names | Resolution |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 36 | Alliance working towards synchronizing the Provider Network datastore with NCTracks. During this time claims may adjudicate improperly (Approve vs. Denied). | 1109 | 09/01/2023 | 221 | 04/09/2024 | No | 04/09/2024 | Closed | Agencies | Claims | No provider action needed. |
| 39 | Claims manually keyed into the portal (CMS1500) as a secondary claim allowed with no PR amount. | 612 | 09/12/2023 | 223 | 04/11/2024 | No | Open | Agencies | Claims | ||
| 54 | When processing the rendering on an 837P currently the rendering submitted in 2420A is taking precedence over the rendering submitted in the 2310B loop. | 5 | 09/15/2023 | 220 | 04/11/2024 | No | Open | Agencies | Claims | ||
| 55 | Some claims are approving with revenue codes 0101 & 0124 on the same DOS for the same patient. These should deny for "R&B service already exists - cannot bill another one." | 6 | 12/27/2023 | 34 | 02/28/2024 | No | 01/30/2024 | Closed | Agencies | Claims | No provider action needed. |
| 56 | Site based claims being approved when the rendering clinician is also set up as a billing provider. The rendering taxonomy is not associated to the rendering NPI. | 162 | 01/10/2024 | 103 | 04/11/2024 | No | Open | Agencies | Claims | ||
| 57 | Health plan edits applied to the statement-period-to date opposed to the claim DOS allowing claims to approve during health plan termination/suspension periods. | 156 | 01/19/2024 | 94 | 04/02/2024 | No | Open | Agencies | Claims | ||
| 58 | Alliance is updating the adjudication process to process claims under EPSDT from based on prior authorization to EPSDT claim submission. | 100 | 01/22/2024 | 91 | 04/11/2024 | No | Open | Agencies | Claims | ||
| 59 | Claims approving in error when the rendering provider is not associated with the billing provider. When resolved claims will be re-adjudicated to deny under edit 140 "Clinician not associated with Provider." | 23 | 09/29/2023 | 206 | 04/11/2024 | No | Open | Agencies | Claims | ||
| 60 | Some claims with a State Benefit Plan are being covered by Medicaid Authorizations. State auths can cover for Medicaid BP claims but a Medicaid auth cannot cover for State BP. | 42 | 02/16/2024 | 66 | 05/16/2024 | No | Open | Agencies | Claims | ||
| 61 | There are secondary COB claims with service lines without PR that are paying the full allowable amount (i.e. more that the PR amount) | 4 | 03/04/2024 | 49 | 05/16/2024 | No | Open | Agencies | Claims | ||
| 62 | Institutional claims have historically adjudicated at the service detail level where each DOS of an inpatient claim is validated individually. This is in conflict in how the NCDHHS system edits claims and Alliance is in discussions with the State on the specific requirements and changes to be made. | 191 | 03/27/2024 | 26 | 05/15/2024 | No | Open | Agencies | Claims | ||
| 63 | Professional Claims with a supervising NPI are approving without a Medicaid health plan for the supervising NPI. | 110 | 04/04/2024 | 18 | 06/13/2024 | No | Open | Agencies | Claims | ||
| 64 | Inpatient stay specifically authorized for revenue 0160 is not covering the stay line on the claim as expected with erroneous denial reason 35. | 21 | 04/08/2024 | 14 | 04/23/2024 | No | Open | Agencies | Claims | ||
| 65 | There are certain claims approving where the health plan is not in an Active status, resulting in erroneous payment. | 1114 | 04/02/2024 | 20 | 04/30/2024 | No | Open | Agencies | Claims | ||
| 66 | Alliance is not actively enforcing the TCM addon to be billed on the same claim as the TCM service. | 6 | 04/11/2024 | 11 | 04/30/2024 | No | Open | Agencies | Claims |
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This page was last reviewed for accuracy on 04/13/2023
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