Feb 06, 2025
System Update: F30 Billing Rejections
Billing providers have reported an increase in claim rejections for the F30 billing edit: "Contact the EIO/D or service coordinator to determine why the
service authorization or associated IFSP is/has a status of 'suspended.'"
As part of the billing validation process, the system issues this rejection
when it detects that a claim’s date range matches with the date range of a ‘Draft’ or ‘Suspended’
IFSP, as billing cannot occur against these statuses.
Effective
February 6, 2025, this edit will include an additional verification of the IFSP status. If the system identifies an IFSP in Draft or Suspended status during the billing validation, it will now also verify whether an Approved, Active, or Closed IFSP exists for the same date range. If one is found, the claim will pass the F30 billing edit. This enhancement allows users to continue creating Draft IFSPs without impacting provider billing.
It is important to
note, if a county unlocks an active IFSP, it reverts to draft status, leaving
no active IFSP in the system. Any claims submitted while the IFSP is unlocked
will still result in an F30 billing rejection. To minimize F30 billing rejections,
counties should complete edits promptly when unlocking an IFSP.
Rebilling
Process for F30 Rejections
If you received an F30 rejection, you may rebill the affected claim(s). Follow the steps below based on your billing method:
- For Service Logging providers: On 2/6/2025, PCG will perform a one-time rebill for Service Logging billing providers whose claims were rejected due to the F30 edit.
- For
837 Billing providers: Providers must resubmit claims rejected due to F30. PCG is unable to
generate the 837 file on their behalf.