***IMPORTANT UPDATE for Medicaid EOB Codes (3323, 3324)***
From November 22, 2013 until May 20th, 2014 the new EOB codes 3323 & 3324 were being electronically submitted by Medicaid to providers in the electronic remittance file as the adjustment code: CO45 in error which automatically adjusted-off the rejected claim. On May 20th, for the June 6, 2014 check write, Medicaid corrected the issue and began sending CO4 (the procedure code is inconsistent with the modifier used or a required modifier is missing) for EOB 3323/3324.
Your ACTION is Needed: Please correct and refile any affected claims.
Below is the Medicaid Alert regarding: Procedure/Modifier Combination Requirements, dated October 22, 2013.
Also note: Currently Alabama Medicaid does not accept modifier 50.
Procedure/Modifier Combination Requirements
October 22, 2013
TO: All Providers
Effective October 21, 2013, the Alabama Medicaid Agency will begin use of two new Explanation of Benefit (EOB) codes.
The new EOB codes will be:
- EOB 3323 Procedure restriction – Required modifier not present
o A procedure code was submitted without the required modifier.
- EOB 3324 Procedure restriction – modifier not allowed
o A procedure code was submitted with a modifier that is not allowed.
Between October 21, 2013, and November 21, 2013, these codes will be returned as informational messages only. Effective November 22, 2013, claims will be denied when submitted without the correct procedure and modifier combinations.
Visit http://medicaid.alabama.gov/news_detail.aspx?ID=8271 for more information.