Claims adjusted in error due to an issue that affected some professional claims for the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model

LOB

Part B

Issue

CMS is aware of an issue that occurred on July 26, 2024, that affected some 2021-2024 professional claims for the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model. If the reprocessed claim resulted in a complete recoupment of the ACO service, the demonstration message 92 will not display on the remittance advice. First Coast is working with CMS to correct this issue. 

Reference: MLN Connects newsletter: September 19, 2024

Resolution

First Coast will reconcile the impacted claims, including:

• Adjusting or refunding amounts you owe
• Recouping funds we paid in error

Status

Open

Provider action

Providers don't need to take any action on these claims for the reconciliations to occur.

Current processing issues

Here is a link to a table of current processing issues for Part A and Part B.