Provider Alert: Erroneous Denial of Secondary Claims
As part of our claims platform migration work, we have identified that secondary enrollment records were not populated correctly. This caused a claims routing error resulting in unpaid secondary claims for dual aligned members under our former Optima Health plan with 2023 dates of service. This unintended outcome included unpaid claims for Medicaid services, and we recognize the significant and negative impact it has had on our provider partners.
As of this communication, the impacted enrollment records have been loaded correctly and we are actively moving secondary claims into the appropriate system for processing. We expect this work to be completed on Wednesday, February 7, by the end of the day. We have already begun processing corrected payments to providers.
We will send out a follow-up notice when all claims have been loaded correctly and we will inform you of the claims reprocessing date. We are establishing a dedicated team to support providers through the resolution of this issue, and we will advise how this team can be contacted.
We appreciate your continued partnership and patience.
Sincerely,
Your Sentara Health Plans Team