Denials from Florida Medicaid “Provider Not Credentialed / Invalid Provider”

February 26, 2014

In January 2014, we identified a high number of denials from Florida Medicaid, “provider not credentialed/invalid provider.”   Upon review of certain Medicaid claims and calls to Medicaid Florida, the Medicaid Florida system was incorrectly denying claims for CLIA certification errors as far back as December 2013, due to a system error.  These claims have since been refiled, and we are now receiving payments.

Medicaid Florida Denial codes on Explanation of Benefits are MA120 Missing/incomplete/invalid CLIA certification, and CO 16 Claim/service lacks information which is needed for adjudication.

Review your biller’s denials reports for these remark codes and be sure to refile your claims for payment.

Wendy Payette, Director of Auditing, Vachette Pathology / Stark Medical Auditing.

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