DESCRIPTION OF THE ISSUE
While filing V61.20 Dx codes either as primary, secondary or tertiary claims were denied for “Invalid Dx under provider’s contract”. We are not suppose to file Dx V61.20. for this provider towards MCD and its HMOs
CONCEPT
Provider should renew his contract to get reimbursed for the claims filed with Dx V61.20 since the provider is not in contract to perform the same.
SOLUTION
On receiving denials from the carrier we started omitting DX V61.20 and refiled the claims with the other available DX codes. This enabled reimbursement of claims. Hence forth we Charge entry executives were instructed to avoid filing Dx V61.20. for Medicaid and its HMO claims.
