ForwardHealth Portal System Update: Error Code 100
On August 15, the ForwardHealth Portal went through a system update to prevent errors with claim decisions and decrease the wait time for adjudication. Error code 100–"Denied as duplicate claim” occurs when multiple claims are submitted to a prior authorization (PA) for the same date of service. This code pays one claim and suspends the second claim to be manually reviewed. The code has been updated to prevent claims from being incorrectly suspended and denied.
The system now:
- Correctly denies second claims that are duplicates. Providers cannot submit more than one claim to the same PA for the same participant, date of service, service code, and modifiers.
- Correctly pays claims that are not duplicates. Providers that have more than one PA may submit claims to each PA number for the same participant, service code, and date of service without the claim denying as duplicate.
Examples of this may include: Two home modification services on the same day with two different PA numbers. For fiscal management services, two different caregivers delivering the same service, on the same day, with different PA numbers.
Providers can review claim decisions in the ForwardHealth Portal and resubmit claims that were incorrectly denied.
Have questions or need help with claims?
If you have questions or need help, please contact the CLTS Operations Team at cltsoperations@gainwelltechnologies.com or 844-942-5870.
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