Provider Notification of Mass Adjustment

Blue Cross Blue Shield of North Dakota (BCBSND) wants to inform providers of an upcoming Medicaid Expansion mass adjustment that will take place to correct claims for coordination of benefits (COB) needing primary carrier information, which were processed with a CO45 ANSI code denial.

It was determined through review that a different rejection should apply to assist in provider clarity regarding the scenario going back to January 2022. Effective July 21, 2023, and upon mass adjustment, claims will receive a rejection of CO22. The mass adjustment process has started and will be completed by September 30, 2023.

Providers impacted by this change will receive new remittances with the updated rejection information. If a provider needs to then send in the primary carrier information, a claim correction needs to be submitted along with the primary carrier’s EOB. Final submission of corrected claims that will be considered for adjudication (including replacement, resubmission, or void claims) must occur within 180 days from the adjustment finalization date.

While it should not be an issue for many claims, if the timely filing limit applies, a provider is advised to submit a claim correction with the primary carrier information, as well as a Not Otherwise Classified (NOC) note, located in loop 2400 SV101-7, stating the adjustment claim is related to CO45 denial for an additional review to be completed to bypass timely filing for this specific claim situation.

If you have additional questions regarding this mass adjustment, please contact the Medicaid Expansion Provider Service Center at 1-833-777-5779.