Support
 

Waystar: Erroneous Claim Rejections — Medicaid Ohio (SKOH0) and Affiliated Payers

Waystar has made us aware that on Tuesday, May 2, 2023, Ohio Medicaid Enterprise System (OMES) EDI implemented a change which caused claims to erroneously reject for E181 — Invalid affiliation between Rendering and Billing provider. Impacted claims would have produced an 824 transaction and HTML report with a reject code of E181. 

The issue was caught immediately and reversed on Wednesday, May 3, 2023. Claims submitted during the duration between May 2, 2023, 8:00 PM Eastern Time (ET) through May 3, 2023, 5:00 PM ET would have received rejects for invalid Rendering and Billing provider affiliation in error. 

Payers Affected: 

  • Medicaid Ohio (SKOH0)       
  • Medicaid Ohio — Amerihealth Caritas Ohio (35374)
  • Medicaid Ohio — Amerihealth Caritas Ohio – Transportation Only (42435)
  • Medicaid Ohio — Anthem EyeMed Vision (SKOH10)
  • Medicaid Ohio — Anthem Ohio Medicaid (SKOH5)
  • Medicaid Ohio — Buckeye Envolve Vision (SKOH7)
  • Medicaid Ohio — Buckeye Ohio Medicaid (SKOH3)
  • Medicaid Ohio — Caresource Ohio – Vision (SKOH6)
  • Medicaid Ohio — Caresource Ohio Medicaid (SKOH2)
  • Medicaid Ohio — Humana EyeMed (SKOH9)
  • Medicaid Ohio — Humana Ohio Medicaid (61103)
  • Medicaid Ohio — Molina March Vision (SKOH8)
  • Medicaid Ohio — Molina Ohio Medicaid (SKOH4)
  • Medicaid Ohio — United Healthcare OH Medicaid (88337)
  • Medicaid Ohio — United Healthcare OH Medicaid – Vision (83572)

Waystar Action Required by Client:

Waystar requires that clients resubmit any claims originally submitted between May 2, 2023, and May 3, 2023, receiving rejection error code E181 with a message similar to:

“E181RENDERING PROVIDER AND BILLING PROVIDER AFFILIATION HAS NOT BEEN ESTABLISHED (A3:585:PR)”

If you have any questions regarding this notice, please contact our Support Team.

 

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