Update re: 3% Physician Services Rate Reduction Claims Reprocessing

As previously announced on April 14, 2015, the reprocessing of claims to recapture the 3% physician services rate reduction is currently underway. (See link below.)

Some providers have reported the reprocessing resulted in the denial of claim details that previously paid. Examples include claim details failing for NCCI edits, retroactive changes in eligibility for Medicaid or Medicare, and service limits.

However, research on the examples reviewed to date indicates that the claim details were denied appropriately during reprocessing. Note that while some edits were bypassed as part of the claim reprocessing, changes made to the system that were effective with date of processing will apply to reprocessed claims, regardless of the date of service.

The 3% physician services rate reduction claims reprocessing continues through the June 23 checkwrite. We will continue to monitor the claim reprocessing results and post additional updates, as needed.