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Known Issue Tracker

Known Issue Tracker
Issue IDIssueNo. of Impacted ProvidersDate Issue FoundNo. of Days OutstandingEstimated Fix DateInterest Penalties OwedDate ResolvedStatus NameProvider Type NamesCategory NamesResolution
22Unable 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.19208/14/202345NoOpenAgenciesClaimsImpact Report sent to claims on 9/11.
28Claim paying at the incorrect HRCCR rate. This was happening due to an overlapping rate under the Physician services fee schedule.2508/21/202338NoOpenAgenciesClaims
29Institutional Outpatient ED claims pended for payment when missing a required CPT/HCPCS code309/01/202327NoOpenAgenciesClaims
32Claim COB information was only submitted at the header level. Claim should deny with - 253 - "Please resubmit claim with line level primary payer adjudication."208/30/202329NoOpenAgenciesClaims
33Claims should have denied as the attending taxonomy is missing on the claim.12108/29/20233009/26/2023NoOpenAgenciesClaimsEdit 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
34A 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.4709/13/2023709/22/2023No09/20/2023OpenAgenciesClaims105 837I files were reprocessed and all claims were re-adjudicated Wednesday 9/20.
35Parsing 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.1509/22/2023609/29/2023NoOpenAgenciesClaims
36Current 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.9999909/01/20232710/06/2023NoOpenAgenciesClaims
37Multiple 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.409/12/20231610/01/2023NoOpenAgenciesClaims
This page was last reviewed for accuracy on 04/13/2023