SPECIAL BULLETIN COVID-19 #4: Billing Requirements Modified in Response to COVID-19

Thursday, March 19, 2020

To ensure beneficiaries continue to receive Medicaid and NC Health Choice services with no interruption or delays due to the COVID-19 outbreak, the disposition for three claim processing edits have been temporarily changed:

  • Edits 02437 and 02425 – “Service Facility Provider Invalid or Not Active on Dates of Service” and “Service Facility Provider Invalid or Not Active on Dates of Service. QMB Recipient” have been changed to pay and report effective with date of processing March 13, 2020. Service facility NPI validation has been waived beginning with dates of processing March 13, 2020, in response to the COVID-19 outbreak.
  • Edit 07025 – “Rendering Provider Not Affiliated with Billing Provider” has been changed to pay and report effective with date of processing March 13, 2020. The requirement that an individual provider affiliate with the billing organization has been waived beginning with dates of processing March 13, 2020, in response to the COVID-19 outbreak.

The edit disposition of pay and report is temporary. Providers will be notified when the edit disposition will change to deny.
Additional information for Medicaid providers is available here.

Author: 
GDIT, (800) 688-6696