June 30, 2021: Outpatient Hospital Claims Denied for Other Insurance

June 30, 2021: Attention Outpatient Hospital Providers: As a reminder, when reporting other insurance on Outpatient claims the OI must be reported at the service line level. For claims denied with Claim Adjustment Reason Code(CARC) 23 "The impact of prior payers' adjudication including payments/and or adjustments", if the other insurance information is reported at the header of the claim and there is a CARC reported from the other payer that is considered a denial (example: CARC 50) or would cause the claim to suspend (example: CARC 16) the claim is denied by CHAMPS. Claims will need to be rebilled with the other insurance information reported at each service line level for correct processing or providers will need to contact the primary payer to further resolve the primary payers' actions. 

For additional resources, reference the Medicaid Provider website: www.michigan.gov/MedicaidProviders >> CHAMPS >> Claims and Encounters >> Other Insurance Reporting Requirements