There are several reasons a service authorization will be rejected. If you open the service authorization, at the bottom of the screen, it will give you the reason for rejection. If you can not determine the cause by this reason, please contact the help desk either by phone or by submitting a ticket.
Error types, definitions, and how to fix them:
06 - Recipient not Eligible
Definition: Consumer lost Medicaid eligibility before service authorization (SA) sent to FMMIS
Fix: Check consumer's eligibility and address the issues for eligibility to be restored
10 - Duplicate PA
Definition: There is another SA in FMMIS that overlaps with the newly created SA
Fix: Check FMMIS to see which PA needs to be addressed
75 - Sum of claims greater
Definition: SA allocation is lower than what the provider has billed on the PA in FMMIS
Fix: Check PA claims in FMMIS to see if the provider has over billed or increase the allocation on SA to at least the amount of the paid claims
79 - no description given
Definition: SA has been cancelled in ABC, but not in FMMIS due to the fact that the provider has billed against the PA
Fix: Check FMMIS to find the PA and re-create the SA in ABC. Email APD Help Desk with a request to have the PA number re-assigned. Address the issue of whether or not the provider was authorized to bill
L3 - Line item not found
Definition: A balance in FMMIS is zero
Fix: If funds were added to the SA, the provider needs to void the last paid claim. Then the SA needs to be re-sent to FMMIS to update the PA balance
L4 - Invalid authorized amount
Definition: Allocation on the SA is zero
Fix: Enter the correct allocation and re-send to FMMIS for PA number
L5 - Invalid unit rate
Definition: Unit rate on SA is zero
Fix: Enter the correct rate and re-send to FMMIS for PA number
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