We're working to resolve Medicaid claims being rejected incorrectly

We’re experiencing an issue with some Medicaid claims front-end rejecting for “Referring/Ordering/Attending is not Enrollment Type 1/Individual” when they shouldn’t. This issue started on February 22. The edit is being applied incorrectly in some cases because it’s checking claims for the provider’s enrollment type and business status when it should only be checking enrollment type.

Our teams are working diligently to resolve this issue.

  • In-state / in-network providers: Claims incorrectly rejected for this edit would still have been rejected due to inactive CHAMPS status on the date of service. Please check your CHAMPS status.
  • Out-of-state providers: There’s no need to rebill. Impacted claims will be reprocessed for payment automatically when the issue is fixed. We’d also encourage you to check your CHAMPS active status, as it may impact how this edit applies to your claims.

We value your partnership and the care you provide our members, and we sincerely apologize for any inconvenience this has caused. Thank you for your patience and understanding.

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