Issue Identified and Resolved for Medicare Claims Submitted with Modifier 50

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) recently identified an issue related to provider submission of Medicare Advantage and Experience Health claims with modifier 50.

Medicare Advantage and Experience Health claims have always followed the CMS filing guidelines of submitting modifier 50 with a single unit. An inappropriate edit was identified causing modifier 50 with 1 unit to reject for claims dating back to 1/1/24.

Blue Cross NC corrected the issue on 6/14/24, and providers may now submit Medicare Advantage and Experience Health claims with modifier 50 using 1 unit. Previous claims that were rejected with a “P322 Units must be greater than one (1) when a Modifier of ‘50’ is entered“ message should be resubmitted.

For questions, please call Medicare HMO Member Line 888-310-4110 or Medicare PPO Member Line 877-494-7647.