Apr 10, 2011 | Medical billing basics
DESCRIPTION OF THE ISSUEWe haven’t filed claims with N and NU ESPDT codes for physical examination procedures. Hence we received denial stating “Invalid/need referral check codes” CONCEPTFor Physical examination codes (99381-99395) we must enter Child Check up...
Apr 8, 2011 | Medical billing basics
DESCRIPTION OF THE ISSUEMedicaid does not accept new born services filed with Parent’s Medicaid ID. Claims were denied for request of exact patient’s Medicaid ID. CONCEPTMedicaid requests patient’s parent to get registered for the new born under Medicaid. ...
Apr 7, 2011 | Medical billing basics
Coding and Payment Rule Appeals A Coding and Payment Rule Appeal is a written request from a licensed health care practitioner for reconsideration of a health care claim based on BCBSF’s application of its coding and payment rules and methodologies (including without...
Apr 5, 2011 | Medical billing basics
DESCRIPTION OF THE ISSUEWhile 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 CONCEPTProvider...
Apr 4, 2011 | Medical billing basics
Provider Appeals Providers may request reconsideration of how a claim processed, paid or denied. These requests are referred to as appeals. There are four different types of appeals: • Coding and Payment Rule Appeals • Utilization Management Appeals • Adverse...
Apr 3, 2011 | Medical billing basics
cpt code – j7613, j7609 DESCRIPTION OF THE ISSUEClaims filed without or incorrect NDC#s, MCD HMO carriers (Staywell/Health Ease) rejected entire claim for NDC# updates, instead of processing denial only for J Codes. CONCEPTAll injection drug codes should be...
