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We’ve identified common ACE Claim rejections and wanted to share information to help with claim submission accuracy and payment for the HRSA COVID-19 Uninsured Program. ACE Claim rejections require review and rework as applicable prior to resubmission for payment consideration. Please consider the edit information below to help you when you submit future claims.

Smart Edit

Smart Edits Message

Sourcing or Description for Smart Edit

Effective Date

Claim Type

uELIG

REJECT (uELIG) The temporary member ID for the HRSA COVID Uninsured Program is inactive for the date of service. Review information related to this temporary member ID by visiting the program portal at coviduninsuredclaim.linkhealth.com/registration.

The temporary member ID for the HRSA COVID-19 Uninsured Program is inactive for the date of service. You can review information related to this temporary member ID by visiting the COVID Uninsured Portal at: COVIDUninsuredClaim.linkhealth.com/registration.

4/30/2020

Professional and Institutional

uCOVP

This claim does not meet diagnosis and/or procedure code requirements for testing or treatment per HRSA COVID-19 Uninsured Program Guidelines. It is rejected and will not be processed.

Claims submitted for reimbursement must meet effective date of service, diagnosis, place of service, and procedure code guidelines. For more information on the program guidelines, please refer to COVIDUninsuredClaim.linkhealth.com/billing-codes.html.

4/30/2020

Professional

DCP

This claim appears to be a duplicate of a previously submitted claim. It has been rejected and will not be processed.

This claim appears to be a duplicate of a previously submitted claim. It has been rejected and will not be processed.

4/30/2020

Professional

uNVP

Per Medicare guidelines, procedure code <1> is not valid for reimbursement.

Please refer to the CMS website at CMS ICD-10 CM guidelines: CMS.gov for Medicare and Medicaid National Physician Fee Schedule.

7/2/2020

Professional

mBC

Per CMS guidelines, payment for procedure code <1> is always bundled into payment for other services not specified and no separate payment is made.

Please refer to CMS.gov/Medicare/Coding/NationalCorrectCodInitEd for additional information on NCCI billing guidelines. Scroll to the bottom of the page to access the NCCI policy manual effective Jan. 1, 2020 zip file. Once the file is open, locate the correct chapter for the code range in question. All files do not have to be unzipped to locate the chapter that is needed.

4/30/2020

Professional

uCOVLAB

Per HRSA COVID-19 Uninsured Program Guidelines, only the COVID-19 test procedure code should be submitted if a COVID-related diagnosis is not submitted on the claim.

Claims submitted for reimbursement must meet effective date of service, diagnosis, place of service, and procedure code guidelines. For more information on the independent lab billing guidelines, please refer to COVIDUninsuredClaim.linkhealth.com/billing-codes.html.

5/21/2020

Professional

MODf

Use of modifier(s) <1> is not typical for procedure code <2>.

Please refer to CMS website at CMS.gov for CMS NCCI Policy, Chapter 1.

4/30/2020

Institutional

OUTPT

This claim appears to be a duplicate of a previously submitted claim. It has been rejected and will not be processed.

This claim appears to be a duplicate of a previously submitted claim. It has been rejected and will not be processed.

4/30/2020

Institutional

LCI

Per LCD or NCD guidelines, procedure code <1> has not met the associated Diagnosis Code relationship criteria for CMS ID(s) <2>.

National Coverage Determination guidelines are developed by CMS for specific services. Smart Edits based on NCD requirements evaluate claim data for age, gender, code-to-code relationships, and allowable units. NCD policies are specific to the service that was performed. The alphabetical index for all Medicare NCDs can be found here: CMS.gov/medicare-coverage-database/indexes/ ncd-alphabetical-index.aspx.

5/14/2020

Institutional

uOPLABf

Per HRSA COVID-19 Uninsured Program Guidelines, services that are not for COVID-19 testing should not be submitted for payment with COVID-19 lab tests.

Please refer to COVIDUninsuredClaim.linkhealth.com/billing-codes.html for policy information.

5/17/2020

Institutional

uCOVPf

This claim does not meet diagnosis and/or procedure code requirements for testing or treatment per HRSA COVID-19 Uninsured Program Guidelines. It is rejected and will not be processed.

Claims submitted for reimbursement must meet effective date of service, diagnosis, place of service, and procedure code guidelines. For more information on the program guidelines, please refer to COVIDUninsuredClaim.linkhealth.com/billing-codes.html.

4/30/2020

Institutional

To get up to date information please visit the medical billing software