Claims Denying Appropriately for Edit 349

Providers have reported increased claim denials for Edit 00349 (SERV DENIED FOR PCPB OR PCPC) with EOB 06702, which has the description "SERVICE COVERED BY PIEDMONT CARDINAL HEALTH PLAN." These claims have denied appropriately. Edit 00349 uses procedure, diagnosis and provider information to determine if services billed are mental health/substance abuse services which should be billed to the Local Management Entity (LME). At the direction of the N.C. Department of Health and Human Services (NC DHHS), Edit 00349 was recently revised to include provider information that was previously missing. Services denied for EOB 06702 should be submitted to the LME for payment. LME contact information can be found on the DMA website. (See link below)