| Providers in AR, CO, LA, MS, NM, OK, TX, Indian Health & Veteran Affairs | |
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The claims issues log below includes the status of claims processing issues that have been identified. We are actively working with the necessary areas/entities to resolve these issues. If your claim issue is not identified below, please visit our FAQs page (JH)(JL), to view top inquiries on claim status, claim denials, and other topics. Please review this log before calling our Provider Contact Center. 855-252-8782 (JH) 877-235-8073 (JL)
Date reported |
Providers impacted |
Workload impacted |
Description/claim coding impact |
Proposed resolution/fix/action required |
Status |
12/12/2025 |
JH/JL providers |
Clinical Laboratory Improvement Act (CLIA) waived tests. |
Certain claims for clinical laboratory tests were incorrectly denied for dates of service on or after October 1 – December 1, 2025. Reference: MLN Connects 2025-12-11 |
Claims will be reprocessed, no further action is required from providers at this time. |
Open |
12/04/2025 |
JH/JL providers |
Overpayment initial request letters for VA duplicate payments were created in error and will be closed out to prevent monetary funds from being collected. |
We have identified an issue with overpayment initial request letters dated December 1, 2025 – December 10, 2025, indicating accounts receivables mentioning this reason for overpayment were created in error and will be closed out to prevent monetary funds from being collected.
Reason for overpayment:
The submitted date of service and procedures have been previously paid resulting in duplicate payment made to the provider. Medicare does not pay for service authorized by the VA, and Medicare regulations prohibit payment of services paid for by another government entity. |
No further action is required from providers on these accounts receivable. |
Open |
11/21/2025 |
JH/JL providers |
Claims processing issue causing claim denials. |
We have identified an issue as a result of Procedure to Procedure (PTP) edits implemented, October 1, 2025, for CPT code 90480. Providers are receiving denials when billing claims for COVID and other vaccines provided on the same day in error. |
No provider action required. Claims denied in error will be adjusted. |
Open |
11/11/2025 |
JH/JL providers |
Claims processing issue causing claim denials. |
We have identified an issue with conflicting Medicare Advantage (MA) plan enrollment between the HIPAA eligibility transition systems (HETS) and the claims processing system causing claim denials. |
We will start to hold claims from denying for MA plan enrollment. Once the resolution has been implemented, we will adjust impacted claims. |
Open | Archive of resolved claim issues - Part B
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