As stated in the
Providers were told that until that edit implementation, paid history would be examined and claims disallowed if found to be submitted with an OCC 6 by a Part D enrolled provider.
Claims voided as a result of this first review appear on the Remittance Advice dated March 27.
If necessary, corrected claims may be resubmitted to the Program on-line within ninety (90) days of the date of service.
Providers should contact the member plan if they are unsure of the Part D claim submission time.
BILLING CARDHOLDERS FOR DISALLOWED OCC 6 CLAIMS IS A VIOLATION OF THE PACE PROVIDER AGREEMENT.
Questions may be directed to Provider Services at 1-800-835-4080.