KanCare 3.0 Closed Claims Resolution Log

The KanCare 3.0 Closed Claims Resolution Log is a Kansas state Medicaid agency administrative document tracking resolved claims payment issues under the KanCare managed care program. Each entry identifies a discrete billing or reimbursement error, the affected provider type or service category, the applicable policy reference, the MCO system implementation date, the reprocessing completion date, and whether the resolution produced an overpayment recovery or underpayment correction. The log covers issues added between January 2021 and July 2021 and documents actions taken by three MCOs: Aetna Better Health (ABH), Sunflower Health Plan (SF), and UnitedHealthcare (UHC). The log records both systematic claim configuration errors and policy-driven rate adjustments. Configuration errors include: vaccine claims incorrectly rejected when billed at zero dollars (Issue 287); maternal depression screening codes 96160 and 96161 denied in error for lack of prior authorization (Issue 305); an incorrect National Drug Code validation table causing claim denials (Issue 295); and Spenddown processing failures for certain member eligibility combinations (Issues 291, 292, 299). Policy-driven adjustments include rate updates for Nursing Facilities and Nursing Facilities for Mental Health (Issues 265, 281, 282, 297, 302, 313, 320), Psychiatric Residential Treatment Facilities (Issue 266), Critical Access Hospitals (Issues 269, 290), Swing Beds (Issue 284), and Indian Health Services (Issues 288, 307). Coverage changes logged include: COVID-19 multiplex testing codes 87635, 87636, and 87637 (Issue 267); COVID-19 vaccine administration for Pfizer (codes 91300, 0001A, 0002A), Moderna (91301, 0011A, 0012A), and Janssen (91303, 0031A), including a pause and resumption of Janssen administration following the April 13, 2021 FDA/CDC statement (Issues 280, 296, 309, 311); discontinuation of Bamlanivimab monotherapy codes M0239 and Q0239 following FDA EUA revocation (Issue 316); and coverage of Silver Diamine Fluoride code D1354 for Medicaid members ages 0-20 and CHIP members ages 0-19 (Issue 268). Medication Assisted Treatment drug rate updates for Opioid Use Disorder G-codes were implemented retroactive to January 1, 2021 (Issue 322). Resolution outcomes are recorded as overpayment, underpayment, or both. Several entries document recovery letters issued to MCOs and completion dates for reprocessing projects. For example, HCPCS annual 2021 changes (Issue 274) resulted in ABH underpayment correction completed March 22, 2021, and overpayment recovery completed June 14, 2021. New DRG Grouper version 38.1 (Issue 279) produced an ABH underpayment correction completed February 26, 2021, and overpayment recovery completed May 19, 2021. The log states that completed issues are removed after 30 days and that historical versions are archived on the KMAP Provider Portal.