Web Announcement 3983

Immediately: Billing team must implement corrective actions for nine specific claim denial error codes. (1) For error code 452 (Medicare crossover claims): Verify co-insurance, deductible, and copay amounts in Medicare crossover details fields; reference Billing Information webpage and PWP User Manual Chapter 3. (2) For error code 1010 (rendering provider not linked): Verify rendering provider is enrolled with Nevada Medicaid for dates of service; access PWP 'Affiliated Providers' page to check linkage; submit linkage update request via PWP if provider is not linked; reference Web Announcement 2982. (3) For error code 1047 (performing provider terminated): Verify performing NPI is enrolled with Nevada Medicaid for dates of service using Search Provider tool; submit new enrollment application via Provider Enrollment webpage if not contracted. (4) For error codes 1076 and 1009 (billing provider contract issues): Verify billing provider contract dates cover dates of service; submit new enrollment application via Provider Flex tool if not contracted; reference Provider Enrollment webpage. (5) For error code 1048 (provider terminated at detail level): Verify billing and rendering providers are contracted for dates of service; submit new enrollment application via Provider Flex tool if needed. (6) For error code 1008 (Group/Individual NPI mismatch): Review claims to ensure Group NPI is listed as billing NPI and individual NPI is listed as rendering/performing provider. (7) For error code 5035 (exact duplicate claims): Review claim history and submit adjustment or void duplicate claims via PWP; reference PWP User Manual Chapter 3. (8) For error code 1854 (rendering provider failed to revalidate): Verify rendering provider contract dates cover dates of service; if within 365 days of contract termination, submit revalidation application via PWP; otherwise submit re-enrollment application via Provider Flex tool; reference Web Announcement 3369 and Provider Enrollment webpage. Failure to address these errors will result in continued claim denials.