At the close of 2024, PCG
conducted a claims reconciliation to address duplicate claims that had been
paid by the system. While the funds associated with these duplicate claims were
reconciled, the units were not. To resolve this, a system
update was implemented yesterday, February 18, 2025, to restore the impacted units to the
appropriate Service Authorizations.
What You Need to Know:
- For duplicate claims recouped between December 23,
2024, and January 1, 2025, the associated units were not initially
restored but were replaced on February 18, 2025.
- Since units were not restored when the claims were
reconciled, providers may have experienced an increase in F28 billing
rejections due to insufficient units. F28 billing rejection indicates:
"Contact the EIO/D or service coordinator to amend the Service
Authorization and add more units if applicable."
- Starting February 19, 2025, providers can rebill for
F28 rejections. Billing
providers can use the Child Info and Authorization Report to verify
the units have been restored. Please note that PCG
will not be performing a system-wide rebill for Service Logging users, as
these users would not have been able to create claims with insufficient
units.
Article ID: 545, Created On: 2/19/2025, Modified: 2/19/2025