Claims Payment System ic Errors (CPSE) Update Report Confidential and Proprietary As of: August 17, 2026 Listed below are current CPSE. This log is updated monthly. Please review this log for CPSE updates on status, target dates for reprocessing and resolutions. If you have questions after reviewing the log, please call Provider Services at 1-8 00-488-0134. Unique ID and Description of CPSELine of BusinessDate CPSE was ConfirmedBilling Provider Type(s) Impacted by CPSE (select all that apply) Timeline for Fixing CPSEDate(s) and/or Date Span(s) of Corrected Claims AdjustmentsCPSE StatusUnique ID CSO0686774:Confirmed CPSEBehavioral Health claims billed with diagnosis codes (See Below) denied 9NP (Service not payable for provider), XIR (Invalid diagnosis code submitted) and XPS (Service not payable for provider) and should pay. This is a potential underpayment to claims.Codes Included:F1090,F1091,F1191,F1291,F1491,F4381,F4389 Medicaid1/23/2026 37-Licensed Independent Social Worker (LISW) | 42-Psychologist, Individual | 53-Behavior Analyst | 84-Ohio Department of Mental Health (Community Mental Health) Provider | 95-ODADAS Certified/Licensed (SUD) Treatment Program | 96-Paraprofessional 3/12/20263/23/20264/9/20264/22/20264/20/2026 Target Claims reprocessing date 7/15/2026-7/22/2026Target Claims reprocessing date 8/10/2026-8/17/2026 In Process Unique ID CSO0732140:Confirmed CPSEOutpatient Facility Renal claims were reimbursed at an old contracted rate and should have been reimbursed at the amended contractual rate effective 2/1/2026. This is a potential overpayment/underpayment to claims. Medicaid & MyCare 4/7/2026 59-End-Stage Renal Disease (Dialysis) Clinic 5/1/20265/28/20266/4/20266/11/20266/10/2026 Target Claims reprocessing date 7/13/2026-7/20/2026Claims reprocessed 7/29/2026 Completed Unique ID CSO07414985:Confirmed CPSEInpatient lab codes (see below) paid without applying member responsibility. This is a potential overpayment to claims. Codes included:80503, 80504, 80505, 80506, ,81599, 83020, 84165, 84166, 85576, 85390, 86255, 86320, 86325, 86334, 86335,88104, 88106, 88108, 88112, 88120, 88121, 88125, 88141, 88160, 88161, 88162, 88172, 88173, 88177, 88199, 88300, 88302, 88304, 88305, 88307, 88309, 88311, 88312, 88313, 88314, 88319, 88321, 88323, 88325, 88329, 88331, 88332, 88333, 88334, 88346, 88348, 88350, 88362, 88363, 88375, 88380, 88381, 88387, 88388, 88399, 89240, G0416, G0452 MyCare5/1/2026 20-Physician/Osteopath, Individual 6/2/20266/3/20266/1/20265/27/2026 Target Claims reprocessing date 7/13/2026-7/20/2026Claims reprocessed on 7/15/2026 Completed Unique ID CSO0710826:Confirmed CPSEBehavioral Health claims billed with place of service 2 and 10 denied 4SW (Disallow Verify place of service) when crossed over to Medicaid and should pay. This is a potential underpayment to claims. MyCare5/11/2026 20-Physician/Osteopath, Individual | 24-Physician Assistant | 37-Licensed Independent Social Worker (LISW) | 42-Psychologist, Individual | 47-Professional Clinical Counselor | 54-Licensed Independent Chemical Dependency Counselor | 72-Nurse Practitioner, Individual 5/13/20265/14/20265/19/2026 Target Claims reprocessing date 7/13/2026-7/20/2026Claims reprocessed on 7/21/2026 Completed Unique ID CSO0729158:Confirmed CPSECorrected claims that denied for timely filing recovered previous payment from the original claim and should not have. This is a potential underpayment to claims. Medicaid 5/15/2026 01-Hospital (IP & OP) | 02-Psychiatric Hospital | 20-Physician/Osteopath, Individual | 21-Professional Medical Group | 24-Physician Assistant | 36-Podiatrist, Individual | 37-Licensed Independent Social Worker (LISW) | 39-Physical Therapist, Individual | 42-Psychologist, Individual | 44-Hospice | 45-Waivered Services Organization | 47-Professional Clinical Counselor | 46-Ambulatory Surgery Center | 52-Independent Marriage and Family Therapist | 55-Waivered Services, Individual | 69-Pharmacist, Individual | 76-Durable Medical Equipment Supplier | 80-Independent Laboratory | 84-Ohio Department of Mental Health (Community Mental Health) Provider 6/2/2026 Target Claims reprocessing date 7/13/2026-7/20/2026Target Claims reprocessing date 8/10/2026-8/17/2026 In Process Unique ID CSO0722311:Confirmed CPSEProfessional claims billed with procedure code T1001 (Nursing assessment/evaluation) by two different providers within a 60 day period denied 181 (Disallow exceeds maximum number of units) and should pay. This is a potential underpayment to claims. Medicaid & MyCare 5/15/2026 16 & 60-Home Health Agency 6/11/2026 Target Claims reprocessing date 7/9/2026-7/16/2026Target Claims reprocessing date 8/10/2026-8/17/2026 In Process Unique ID CSO0722714:Confirmed CPSEProfessional claims billed with procedure codes (see below) denied X99 (Not a covered service/procedure) and should pay. This is a potential underpayment to claims. Codes included:90662, 98966, 98967, 98968, 99070, 99173, 99291, 99292, 99408, G0008, G0179, G0180, G0404, G0426, G0427, L3935, S5136 Medicaid & MyCare5/18/2026 20-Physician/Osteopath, Individual | 24-Physician Assistant 6/29/20267/1/2026 Target Claims reprocessing date 7/25/2026-8/2/2026Claims reprocessed 8/6/2026 Completed Unique ID CSO0761306:Confirmed CPSEProfessional claims billed with procedure codes 90791 (Psychiatric diagnostic evaluation) and 90792 (Psychiatric diagnostic evaluation with medical services) denied Z50 (Medicare Non-Covered Service) and should pay. This is a potential underpayment to claims. MyCare5/28/2026 20-Physician/Osteopath, Individual | 37-Licensed Independent Social Worker (LISW) | 42-Psychologist, Individual | 47-Professional Clinical Counselor | 52-Independent Marriage and Family Therapist | 54-Licensed Independent Chemical Dependency Counselor | 72-Nurse Practitioner, Individual 7/8/20267/16/20267/23/2026 Target Claims reprocessing date 8/5/2026-8/12/2026Target Claims reprocessing date 8/12/2026-8/19/2026 In Process Unique ID CSO0752974:Confirmed CPSEBehavioral health claims billed with diagnosis (see below) denied 41R (Disallow Invalid ICD9/10-CM diagnosis) and should pay. This is a potential underpayment to claims. Codes included:F50010, F50011, F50019, F50020, F50021, F5022, F50811, F50812, F5089 Medicaid & MyCare 5/29/2026 20-Physician/Osteopath, Individual | 24-Physician Assistant | 37-Licensed Independent Social Worker (LISW) | 96-Paraprofessional | 47-Professional Clinical Counselor | 72-Nurse Practitioner, Individual 7/9/20267/16/2026 Target Claims reprocessing date 8/21/2026-8/28/2026 In Process Private and Confidential Unique ID and Description of CPSELine of BusinessDate CPSE was ConfirmedBilling Provider Type(s) Impacted by CPSE (select all that apply) Timeline for Fixing CPSEDate(s) and/or Date Span(s) of Corrected Claims AdjustmentsCPSE StatusUnique ID CSO0759797:Confirmed CPSEProfessional claims billed with procedure codes (see below) for Out of Network providers with place of service 31, 32 and 33 paid and should deny PA required-non par provider. This is a potential overpayment to claims. Codes included:36415, 70110, 70140, 70150, 70360, 71045, 71046, 71100, 71101, 71110, 72020, 72040, 72050, 72070, 72083, 72100, 72120, 72170, 72220, 73000, 73020, 73030, 73060, 73070, 73080, 73090, 73100, 73110, 73120, 73130, 73140, 73502, 73503, 73521, 73522, 73551, 73552, 73560, 73562, 73564, 73590, 73600, 73610, 73620, 73630, 73660, 74018, 74019, 76514, 76536, 76604, 76642, 76700, 76705, 76770, 76775, 76856, 76857, 76870, 76882, 93000, 93005, 93010, 93306, 93308, 93880, 93922, 93925, 93926, 93970, 93971, 93975, P9603, P9604, Q0092, R0070, R0075 Medicaid & MyCare6/1/2026 20-Physician/Osteopath, Individual | 24-Physician Assistant | 80-Independent Laboratory 7/23/20267/29/20268/3/20268/10/2026 Target Claims reprocessing date 8/20/2026-8/27/2026 In Process Unique ID CSO0761191:Confirmed CPSEProfessional claims billed with procedure code 92273 "Electroretinography (ERG), with interpretation and report; full field (i.e., ffERG, flash ERG, Ganzfeld ERG)" denied Z50 (Medicare Non-Covered Service) and should pay. This is a potential underpayment to claims. MyCare6/4/2026 35-Optometrist, Individual 7/24/20267/1/2026 Target Claims reprocessing date 8/21/2026-8/28/2026Claims reprocessed on 8/3/2026 Completed Unique ID INC1611521:Confirmed CPSECorrected claims for laboratory procedure codes (see below) were being denied AV3 (Avalon Insufficient time between procedures) and should pay. This is a potential underpayment to claims. Codes included:80061, 82105, 82306, 82378, 82607, 82670, 82728, 82947, 82977, 83036, 83521, 93615, 83880, 84075, 84439, 84443, 84445, 84702, 84703, 85652, 86038, 86039, 86140, 86141, 86231, 86258, 86301, 86364, 86376, 86592, 86704, 86706, 86800, 86803, 87340, 87522, 87624, 88141, 88142, 88143, 88175, G0482, Q0091 Medicaid & MyCare 6/13/2026 01-Hospital (Inpatient) | 20-Physician/Osteopath, Individual | 21-Professional Medical Group | 24-Physician Assistant | 72-Nurse Practitioner, Individual | 80-Independent Laboratory 6/13/2026 Target Claims reprocessing date 7/20/2026-7/27/2026Claims reprocessed on 7/27/2026 Completed Unique ID CSO0769100:Confirmed CPSEOutpatient facility claims billed with procedure codes (see below) were not having the member's cost share applied appropriately. This is a potential overpayment to claims. Codes included:43450, 45380, 45381, 45385 MyCare6/16/2026 01-Hospital (IP & OP) | 46-Ambulatory Surgery Center 7/9/2026 Target claims reprocessing date 8/7/2026-8/14/2026Claims reprocessed on 8/11/2026 Completed Unique ID CSO0746903:Confirmed CPSEPhysical therapy and rehab claims were denying for no authorization when an approved authorization was on file. This is a potential underpayment to claims. MyCare 6/16/202639-Physical Therapist, Individual 6/24/2026 Tagret Claims reprocessing date 7/23/2026-7/30/2026Claims reprocessed on 8/4/2026 Completed Unique ID CSO0771129:Confirmed CPSEClaims billed with procedure codes (see below) were pricing incorrectly at higher escalator rate and should have been pricing at the contracted rates effective 2/1/2026. This is a potential overpayment to claims. Codes included:90945, 90999 MyCare6/26/2026 59-End-Stage Renal Disease (Dialysis) Clinic 7/16/2026Target Claims reprocessing date 8/13/2026-8/20/2026 In Process Unique ID CSO0759852:Confirmed CPSEOutpatient claims billed with procedure codes (see below) denied X99 (Not a covered service/procedure) and XNC (Invalid procedure code) and should have paid. This is a potential underpayment to claims. Codes included: A7010, A7013, Q4049, E0656, L3915, L6624, E0657, Q4051, E0635, A6545, A5200, L3935, Q0497, Q0506, Q0501, Q0496, A4436, B4104 Medicaid & MyCare6/29/2026 01-Hospital (Inpatient) | 20-Physician/Osteopath, Individual | 21-Professional Medical Group | 24-Physician Assistant | 36-Podiatrist, Individual | 45-Waivered Services Organization | 72-Nurse Practitioner, Individual 8/24/20268/27/20269/3/2026 Target Claims reprocessing date 9/21/2026-9/28/2026 In Process Unique ID TFS1777753:Confirmed CPSEProfessional claims billed with procedure code 77387 (Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed) denied p08 (Required modifier is missing or invalid) and should pay. This is a potential underpayment to claims. Medicaid & MyCare7/1/2026 20-Physician/Osteopath, Individual | 72-Nurse Practitioner, Individual 7/22/20267/13/2026 Target Claims reprocessing date 8/19/2026-8/26/2026 In Process Unique ID CSO0768871:Confirmed CPSENot CPSEClaims billed with procedure code H0038 (Self-help/peer services, per 15 minutes) denied 5IR (Invalid DX code submitted) and should pay. This is a potential underpayment to claims. Medicaid & MyCare 7/15/2026 37-Licensed Independent Social Worker (LISW) | 47-Professional Clinical Counselor | 72-Nurse Practitioner, Individual | 96-Paraprofessional 7/15/2026 Target Claims reprocessing date 7/17/2026-7/24/2026 Remove from log Unique ID CSO0777420 :Confirmed CPSEEffective January 1, 2026, certain outpatient hospital temporary HCPCS Level II codes (listed below), which are used to report specific outpatient hospital services, procedures, and equipment, were denied UM0 (Services disallowed by Utilization Management Override) for PAR providers. These services should have paid without requiring prior authorization. This is a potential underpayment on claims.Codes Included:C1721, C1722, C1764, C1767, C1772, C1777, C1778, C1779, C1785, C1786, C1787, C1816, C1820, C1822, C1874, C1875, C1876, C1877, C1880, C1882, C1891, C1895, C1896, C1897, C1898, C1899, C1900, C2619, C2620, C2621, C2623, C2625, C2626 Medicaid & MyCare7/22/202601-Hospital (Inpatient) 9/2/2026Target Claims reprocessing date 9/30/2026-10/7/2026 In ProcessPrivate and Confidential Unique ID and Description of CPSELine of BusinessDate CPSE was ConfirmedBilling Provider Type(s) Impacted by CPSE (select all that apply) Timeline for Fixing CPSEDate(s) and/or Date Span(s) of Corrected Claims AdjustmentsCPSE StatusUnique ID CSO0757516:Confirmed CPSEEffective June 30, 2026, the Quality Enhancer Program will officially end, including the termination of the associated incentive agreements. This is a potential overpayment to claims. Medicaid & MyCare8/4/2026 20-Physician/Osteopath, Individual | 24-PhysicianAssistant | 71-Nurse Midwife Individual | 72-Nurse Practitioner, Individual 8/27/2026Target Claims reprocessing date 9/24/2026-10/1/2026 In Process Unique ID CSO0784561:Confirmed CPSEEffective 1/1/2024 Dialysis codes with HCPCS codes (see below) denied X99 (X99 Not a covered service/procedure) and should have paid. This is a potential underpayment to claims.Procedure codes:C7513, C7514, C7515 MyCare8/5/202601-Hospital (Outpatient) 8/27/2026Target Claims reprocessing date 9/24/2026-10/1/2026 In Process Unique ID TFS1809319:Confirmed CPSEEffective 8/1/2026 the 2026 Quarter 3 Optum Claims Edit System Diagnosis file for Inpatient diagnosis codes (see below) denied w61 (Admission diagnosis code is invalid), w72 (Principle diagnosis code is invalid), and w66 (Other diagnosis codes are invalid) and should pay. This is a potential underpayment to claims.Diagnosis Codes:D691, I420, I428, I498, L02232, L03312, L03322, M722, M868X1, M868X2, M868X3, M868X4, M868X5, M868X6, M868X7, M868X8, S23420, S23420A, S23420D, S23420S, T528X, T528X1, T528X1A, T528X1D, T528X1S, T528X2, T528X2A, T528X2D, T528X2S, T528X3, T528X3A, T528X3D, T528X3S, T528X4, T528X4A, T528X4D, T528X4S, Z2914, Z681 or Z87890 Medicaid & MyCare8/5/202601-Hospital (Inpatient) 8/6/2026Target Claims reprocessing date 9/3/2026-9/10/2026 In Process Unique ID CSO0786646:Confirmed CPSEEffective 1/1/2026 Ohio Health Medicaid/FIDE Agreements reimbursement rates for Inpatient and Outpatient services for specific facilities (see below) were pricing at the old contract rates and need to price at new contracted rates. This is a potential overpayment/underpayment to claims.Facilities Include: SouthEast MedicalVan Wert HealthOhio Health BergerO'Bleness MemorialGrady Memorial Medicaid & MyCare08/06/2601-Hospital (IP & OP) 9/10/2026Target Claims reprocessing date 10/3/2026-10/10/2026 In ProcessPrivate and Confidential OH-Multi-P-5983566 a
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The registry is color-coded, so you can easily identify areas of focus for your patients:Green Service was rendered Ye l l o w Service neededRed Service past due Grey Not applicable The registry includes information on but not limited to the following quality measures:Adult accessBreast cancer screeningCervical cancer screeningColorectal cancer screeningChlamydia screening Diabetes Emergency room visitsLead screeningWell-care visit The Perfect Tool to Streamline Your Practice! The CareSource Clinical Practice Registry is an online tool available to health partners to identify and prioritize needed health care services, screening, and tests for CareSource members. The Clinical Practice Registry is easy to access via the secure CareSource Provider Portal.Identify gaps in care: View preventive service history and easily identify HEDIS (Healthcare Effectiveness Data and Information Set) gaps in care to discuss during appointments Holistically address patient care: Receive alerts when CareSource members need tests or screenings, review member appointment histories and view their prescriptionsImprove clinical outcomes: Easily sort CareSource members into actionable groups for population management CARESOURCE CLINICAL PRACTICE REGISTRY For more information, call Provider Services at 1-833-230-2101. How to Access the CareSource Clinical Practice RegistryHealth partners will need to register for the CareSource Provider Portal to access the Clinical Practice Registry.Our Provider Portal is free, secure and easy to use. Provider Portal Registered UsersVisit CareSource.com and click Login > Provider at the top right corner. Enter your username and password and click Login. Four easy steps to register for the portal:1. Click Sign Up to establish your account by creating your username and password.2. For added security, set up the multifactor authentication. 3. To connect your account, you will need your Provider Name, Tax ID, Provider ID and your Zip Code. 4. Review and accept the AgreementPlease note your username and password so you can use it to access CareSources Clinical Practice Registry and the many other helpful tools available on the Provider Portal.Visit the CareSource secure online Provider Portal and see how the CareSource Clinical Practice Registry can easily fit into your daily workflow and help improve patient outcomes!Plans issued by Common Ground Healthcare CooperativeHEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).WI-EXC-P-3131651a | 2026 CareSource. All Rights Reserved.
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