Update on Anthem Medicaid PDPM Claims
What to know: VHCA-VCAL has obtained information from Anthem to assist providers in resolving billing issues related to the transition to Medicaid Patient-Drive Payment Model (PDPM) claims.
- Anthem has supplied information on how to register for its biller alerts service. This is the best source for (almost) real-time information on policy changes and operational issues impacting providers and should be shared with your billing teams.
Review the table below which includes simplified instructions on what should be done when a provider receives a claim rejection response.
| If you see: | Do This: |
| Error 41384: The HIPPS Rate Code [XXXXX] was not found in Code Table HIPPS Codes Invalid Data: [XXXXX] | Rebill the claim using Payer ID 26375. |
| Error 41385: The HIPPS Rate code [XXXXX] was not in effective on [YYYYMMDD], transaction date. | Rebill the claim using Payer ID 26375. |
| Error 499: Required HIPPS/RUGGS/CMG code is missing or invalid. | Anthem is requeuing your rejected claim. No additional action is required of you. We recommend you check Availity again in four business days for an updated claim status. |
Questions? If you have general questions related to this guidance or anything else, email valtssnfsupport@anthem.com.
Also of note, Anthem has informed VHCA-VCAL that the Payer ID issue should be resolved by the end of December, and the manual processing should be resolved in January (but are hopeful it will be earlier).
