Identified Claim Processing Errors - Resolution

Update Feb. 29, 2024- We want to share an update to the previously published article below. Both errors have been corrected and mass adjustments of impacted claims will be done. The adjustments will be completed mid-April. Please contact the Provider Service department on the back of the member ID card if you feel a claim has not been reprocessed accordingly after this date.

Previous Article published Jan. 25, 2024
We are receiving a high-volume of calls into our Provider Service Centers related to the following processing errors that we have identified by Blue Cross Blue Shield of North Dakota (BCBSND).

The first error is related to laboratory codes that were processed between Jan. 1 and Jan. 18, 2024. Claims were incorrectly denied with ANSI code CO97 and an associated remark code of M144, which would show on your remittance advice. This error occurred when any component code was billed that is contained within a laboratory panel code and the component code did not contain a modifier, however the date of service did not contain all the component codes to support the use of a panel code. Claims should no longer be rejected in error as of Jan. 19, 2024.

We also wanted to inform providers that we are working on identifying claims outpatient therapy claims that were impacted by the new policy Physical, Occupational and Speech Therapy Modifiers being implemented on Dec. 18, 2023, instead of the Jan. 1, 2024 effective date. This caused claims submitted prior to Jan. 1, 2024, to be rejected due to the missing modifier(s). The modifier implementation was not in effect in December; therefore, those claims should have processed without the need of the modifiers. We are working on identifying impacted claims and will send an update with claim recovery information. Once a recovery is completed, providers will see new claim processing details on a future remittance.

We will provide additional information through BCBSND HealthCare News weekly as we identify the next steps to correct the processing errors.