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Horizon 98943 Issue Update
As previously reported, we have seen many denials of 98943 from Horizon with the denial reason code: U702: “This service is not paid. This denial occurred because the procedure code has a status indicator of N, I, P, M, R or C. Refer to the Medicare Physician Fee Schedule to determine CMS Guidelines for reimbursement.”
When we reached out to Horizon to address the issue, Horizon advised that these denials are erroneous. They believe the issue is related to a recent upload of new claim edits based on Medicare policy. They anticipate the issue with the edits will be fixed by April 22nd. In the meantime, they have turned off all the edits that had been uploaded and caused this issue. As such, there should be no more 98943 denials on claims processed on or after today. If you receive any such denials please contact me at email@example.com.
Horizon said that once the claim edit issue is resolved, they will reprocess and issue payment for the previously denied 98943 claims. They did not have an estimated time frame for this, but will advise once the claim edit issue is resolved.
The ANJC will continue to communicate with and monitor Horizon regarding this issue and will keep membership informed of the progress.