[Ohioaap-practicemanagers] Important: Caresource holding payment for well visits over their coding issues

[Price, Jonathan]

Has anyone else experienced and/or solved this urgent Caresource issue on well visits? We received the following. Please look at it and post your response:

"Since May 5, 2016 we have big problems with getting payment from Caresource for well visits . For some reason they are  not denying the claims just putting them on eternal hold . I wonder if you can find out on the practice listserv or other means if other practitioners are having the same problem as we are. We have been successfully submitting similar claims to Caresource for years , but now we have problems. We know proper coding and which code for which age and type of visit. Anything you can advise will help as my revenue has hit bottom as a result.

Would you have any contacts at Caresource we can contact? The usual channels know nothing .

We contacted the payer for claim rejection and received the following response. As per the payer response,

 CareSource is aware of two issues that are causing claims to incorrectly rejected. We are making these changes for claims received on or after 5/5/16:
   1) In Loop 2400 SV111, indicator 'Y' should follow CRC02 N and CRC03 NU.
  2) Some CPT codes have an age restriction, while other CPT codes do not. When CPT codes are submitted on the claim without the EPSDT qualifier, claims are being rejected, even though the age is appropriate.

 Thanks for any direction you can provide!
Rachel Garber, MD , FAAP
University Suburban Pediatrics
217-297-2700
 rgarber at ushchealth.com     "

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