ER - Inactive Reference Code Denial

(Doc ID 2254471.1)

Last updated on APRIL 12, 2017

Applies to:

Oracle Health Insurance Claims Adjudication - Version 2.14.2 and later
Information in this document applies to any platform.


When a claim has a reference code (i.e., diagnosis, procedure, modifier, etc.) for which the admission date is prior to the reference code start date, OHI attaches fatal message cla_fl_ppri_002. This causes several steps in our claims flow to be skipped and produces unexpected results.

HPHC requests the edit that attaches this message be updated to see if the reference code start date falls anywhere in the claim DOS span.


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