APD Zendesk

Home       Frequently Asked Questions    
Agent Page      
Follow

Why was service authorization rejected?

There are several reasons a service authorization will be rejected.  If you open the service authorization, at the bottom of the screen, it will give you the reason for rejection.  If you can not determine the cause by this reason, please contact the help desk either by phone or by submitting a ticket.

Error types, definitions, and how to fix them:

06 - Recipient not Eligible
     Definition:  Consumer lost Medicaid eligibility before service authorization (SA) sent to FMMIS
          Fix:  Check consumer's eligibility and address the issues for eligibility to be restored

10 - Duplicate PA
     Definition:  There is another SA in FMMIS that overlaps with the newly created SA
          Fix:  Check FMMIS to see which PA needs to be addressed

75 - Sum of claims greater
     Definition:  SA allocation is lower than what the provider has billed on the PA in FMMIS
          Fix:  Check PA claims in FMMIS to see if the provider has over billed or increase the allocation on SA to at least the amount of the paid claims

79 - no description given
     Definition:  SA has been cancelled in ABC, but not in FMMIS due to the fact that the provider has billed against the PA
          Fix:  Check FMMIS to find the PA and re-create the SA in ABC. Email APD Help Desk with a request to have the PA number re-assigned. Address the       issue of whether or not the provider was authorized to bill

L3 - Line item not found
     Definition:  A balance in FMMIS is zero
          Fix:  If funds were added to the SA, the provider needs to void the last paid claim. Then the SA needs to be re-sent to FMMIS to update the PA balance

L4 - Invalid authorized amount
     Definition:  Allocation on the SA is zero
          Fix:  Enter the correct allocation and re-send to FMMIS for PA number

L5 - Invalid unit rate
     Definition:  Unit rate on SA is zero
          Fix:  Enter the correct rate and re-send to FMMIS for PA number

Was this article helpful?
3 out of 3 found this helpful
Have more questions? Submit a request

0 Comments

Article is closed for comments.