Known Issue Tracker

Known Issue Tracker

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
22	Unable to create SARs because of units exceeded on authorizations. A discontinue date cannot be entered as "Used Units" exceed "Authed Units" and thus reauths cannot be created.	192	08/14/2023	45		No		Open	Agencies	Claims	Impact Report sent to claims on 9/11.
28	Claim paying at the incorrect HRCCR rate. This was happening due to an overlapping rate under the Physician services fee schedule.	25	08/21/2023	38		No		Open	Agencies	Claims
29	Institutional Outpatient ED claims pended for payment when missing a required CPT/HCPCS code	3	09/01/2023	27		No		Open	Agencies	Claims
32	Claim COB information was only submitted at the header level. Claim should deny with - 253 - "Please resubmit claim with line level primary payer adjudication."	2	08/30/2023	29		No		Open	Agencies	Claims
33	Claims should have denied as the attending taxonomy is missing on the claim.	121	08/29/2023	30	09/26/2023	No		Open	Agencies	Claims	Edit corrected after update to allow submission of agency (non-individual) attending information up until 11/1/2023 and to enforce the edit beginning with claims received on or after 4/1/23
34	A number of claims are denying incorrectly for Missing/incomplete/invalid diagnosis or condition. This is due to a parsing issue and Alliance IT staff is working on this with high priority.	47	09/13/2023	7	09/22/2023	No	09/20/2023	Open	Agencies	Claims	105 837I files were reprocessed and all claims were re-adjudicated Wednesday 9/20.
35	Parsing issue. The attending information is correct on the 837 file, but claims are denying for 214: "Invalid or Incomplete Attending Provider submission." The attending npi and taxonomy data in not being parsed from the 837 files into ACS.	15	09/22/2023	6	09/29/2023	No		Open	Agencies	Claims
36	Current PEF Issues: 1. Clinician health plans have overlapping dates- often with two different statuses (ie., active/not). 2. Provider taxonomies- historical data not being updated at time of PEF load resulting in inaccurate active statuses 3. Provider health plans are not updating daily (data in NCT does not match data in ACS) 4. Clinician taxonomies- level 2/classifications- not inactivated (shouldn’t have been loaded; not corrected) 5. Historical site information- updating/adding historical site information is not occurring (impacts retro claims) 6. Duplicate provider records- causing ambiguity 7. Duplicate site records- causing denials because mapping to sites without contract details 8. Clinician taxonomy display- duplicates, triplicates, etc. 9. Clinician Provider Association- dates are not correct (all show 10/1 effective dates, but NCT is much earlier) 10. Locator codes/Site Address do not align with NCT 11. PEF is not loading all data daily (seems like only selected data is loading) The above have all been staffed with Jason and examples provided via emails. Jason is working on these issues.	99999	09/01/2023	27	10/06/2023	No		Open	Agencies	Claims
37	Multiple claims hitting pended that should be denying for service not in contract. The service code is 96372. The claims were submitted with a J code (drug code), so the entire claim will pend for Manual Review under PADP.	4	09/12/2023	16	10/01/2023	No		Open	Agencies	Claims