Opinion ID: 2362031
Heading Depth: 3
Heading Rank: 2

Heading: Quality of St. Clare's Initial Submission

Text: The record is unclear about the nature and extent of the deficiencies in St. Clare's initial submission to Unisys. A certification filed in the remand proceeding by an Economic Research Specialist in the Department of Health stated that Unisys processed St. Clare's initial submission on October 21, 1996 and it was rejected due to missing revenue codes and because the claim detail lines exceeded 45 lines. Another certification in the remand proceeding characterized St. Clare's submission as grossly deficient. The Departments' Appellate Division brief stated that the submission was rejected because of numerous errors such as failure to use correct submitter identification and provider numbers, and submitting claims detail lines that were in excess of readable limits. Northwest's healthcare computer consultant, Elmer Bean, certified that once the Electronic Media Claims (EMC) Error Report was received from Unisys on February 18, 1997, only one day was required for Northwest's staff to correct the deficiencies listed in the error report. Another consultant, Craig Rutledge, certified that after one day's work addressing the problems in the error report, St. Clare's next inpatient and outpatient submissions were usable and were processed by Unisys. He acknowledged that subsequent submissions were necessary to address claims for reimbursement that had been denied.