Understanding disallow code OX6
It’s important to us that you understand the way your claims are handled – including what the various codes that may appear on your remittance advice mean. One claim adjustment code we get a lot of questions about is OX6.
New and updated billing policies are now available
We’ve posted several new and updated billing policies, which align to industry standards, to the Provider Manual.
Resolving some vaccine codes denying incorrectly
We're correcting two issues with vaccine claims denying when they shouldn't.
Provider-based billing policy went into effect June 1
Our provider-based billing policy went into effect June 1.
Understanding why a claim denied
We've created a new resource to help you understand exactly why a claim may have denied and be able to take any appropriate next steps.
New or corrected claims requirement for retro authorizations
Starting Dec. 9, submit new or corrected claims when you get a retroactive authorization after a claim denial.
Submitting requested medical records for claims processing
Follow this process when submitting requested medical records to ensure they're linked with the right claim.
Void claims now appear on remittance advice with original claims
Since June 2024, void claims now appear on your remittance advice with the original claim adjustment.
Resolving claims denying incorrectly for no anatomical modifier
We're reprocessing claims that recently denied for no anatomical modifier when they shouldn't have.
Changes for Medicaid claims for select home health care services
Changes coming for Medicaid claims submissions for select home health care services
ER imaging claims reprocessing
We're adjusting ER imaging claims that rejected incorrectly for no authorization.
Upfront claim rejections for member mismatch
Review the criteria our system looks at to match a claim to one of our members. If any of these don’t match exactly what we have in our system, the claim will be rejected.