Providers may see some claim denials related to U83 (Drug Dosing Modifier is Required) being applied in error.
What's happening?
Claims billed in accordance with the Priority Health Provider Manual (JW/JZ modifier guidance)—with no modifier on line 1—are currently denying inappropriately
What This Means for Providers
- Drug code claims that are correctly submitted without a modifier on line 1 may still deny incorrectly with U83 (Drug Dosing Modifier is Required).
- Both professional claims and facility claims are affected.
- This issue applies to all products.
- Providers should continue to follow current Provider Manual billing guidance.
There’s nothing you need to do
You do not need to submit an inquiry via prism. Impacted claims will be automatically reprocessed once the system update is complete.