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Attention All Providers: Professional and Institutional Claims That Paid in Error Have Been Reprocessed
Act
by Aug 23, 2024
Effective date
Aug 23, 2024
Identified
Jun 21, 2026
Summary
Nevada Medicaid automatically reprocessed claims for physical therapy and occupational therapy evaluation codes (97161-97167) that incorrectly paid when duplicate evaluations were billed in the same calendar year. These claims were denied with error code 6104 for dates of service February 1, 2019 through May 7, 2024.
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What to do
by Aug 23, 2024 · 4 steps
01Review remittance advice dated August 23, 2024 for reprocessed PT/OT evaluation claims.
02Identify any claims now denied with error code 6104 (Evaluation Previously Paid for Calendar Year).
03Verify billing practices to ensure only one evaluation per therapy type per calendar year is submitted.
04If appropriate, prepare appeals for denied claims following Medicaid Services Manual Chapter 100 guidelines.
Codes mentioned
971619716297163971659716697167
Original notice
Attention All Providers: Professional and Institutional Claims That Paid in Error Have Been Reprocessed
medicaid.nv.gov · Always check the source before changing claims.