Retro processing system errors in Cycle 1853 APG rate payment calculations
Two problems were identified with the retro rate processing of certain APG claims that occurred in cycle 1853.
- If a line was originally paid based upon a procedure specific price (APG claim was paid using the APG Fee Schedule), the new payment amount after retro processing for that line that used that procedure specific price was $0.00.
To remediate the situation, CSC has identified the claims that were inappropriately paid and these claims were reprocessed via a special input. This special input reprocessed the claims through the grouper which applied the procedure based fees to the claims once again and was completed in cycle 1854. Of the 13M claims that were retro processed, these claims totaled approximately 400,000 claims. Therefore, NOT ALL PROVIDERS were impacted by this processing error.
Please note that the special input processing of claims WILL NOT negate the negative liability due to NYS that this processing error MAY HAVE generated. Providers are encouraged to review their liability AFTER THE RETRO PROCESSING IN ITEM 2, to determine if there is a balance still due to NYS to be paid. Please read below for a further explanation.
- For claims that were over 2 years old, when these claims were pulled from archives and converted to current history claims for the reprocessing, the flag that identified that capital was paid was removed from the claim. When the claim was then reprocessed, with the capital flag removed, capital was not paid on these claims.
To remediate the situation, CSC has identified the claims for the period December 1, 2009 through approximately the end of January 2011 that were inappropriately paid and these claims will be reprocessed via retro processing. This retro processing will be completed in cycle 1855.
Please note that the retro processing of claims WILL negate the negative liability due to NYS that this processing error MAY HAVE generated for a provider. Since this retro processing will negate the negative liability caused by this error at 100%, it is recommended to review the liability owed to NYS after this retro processing occurs, if applicable.
For providers that still have a negative liability owed to NYS AFTER the retro processing to correct the payments in item 2, the collection of the liability will be completed with the standard policy of 15% of a provider's weekly cycle being applied.