08/24/2017

Caresource Denial Update

Caresource denial issue fixed

(COLUMBUS, OH) OSCA’s Nicholas Strata announced today a fix to the CareSource issue a number of Association members have had state-wide. “Through a concerted effort that involved all parties – OSCA staff, legislative and legal counsel, along with the Department of Medicaid and a DC who sits on the CareSource Board of Trustees, we have established a reason and solution behind the MCO’s denials of our members,” said Nicholas Strata. “We would like to thank all of our members for remaining patient through this process.”

Since the beginning of August, the OSCA has received numerous inquiries related to denials and has worked non-stop to find the reason why. Strata said “earlier this week we had learned the State of Ohio elevated our concern with CareSource. From that point on, communication with them improved tremendously.”

Dr. Brandy Spaulding, Director of Chiropractic Services for the OSCA, said “they acknowledge that an update to their system resulted in an error. Specifically, their system was looking for an extra digit on our diagnosis. Because the extra digit was not there, the system was denying the claims.”

“Once fixed, the subluxation diagnosis codes M99.01, M99.02, M99.03, etc, will continue to be the correct codes. You will not be required to re-bill the denied dates of service. Once the error is fixed, the denied claims will automatically be reprocessed. Additionally, they are asking providers to allow them three weeks to get the problem fixed and have said they will not be pursuing take backs dated to May 2016 as some providers were told,” said Dr. Spaulding. “If you or someone on your billing staff calls into the claims department regarding this issue over the next 3 weeks, you may be given different information. Not all representatives within CareSource may have the most up to date information related to this issue.”

Should you have any questions, please contact Dr. Brandy Spaulding at brandy@oscachiro.org