Dec 23, 2009 | Medical billing basics
Not covered when performed during the same session/date as a previously processed service for the patient. M80 A. Need to check in the system whether the same type of service was billed previously for the same Dos. B. Need to confirm any global period was applicable...
Dec 23, 2009 | Medical billing basics
D55 – Timely limit for filing has expired. Appealed the claim with clearing house acceptance report. D28 – Aetna is not responsible for these charges. if there is no valid referral the member is responsible. Get the referral from PCP and file the claim....
Dec 23, 2009 | Medical billing basics
97 -Payment is included in the allowance for another service/procedure. Check whether the modifier is append for particular line item or take the w.o. 22 -Payment adjusted because this care may be covered by another payer per coordination of benefits. We have to find...
Dec 22, 2009 | Medical billing basics
Timely Filing Every insurance company has a time window in which you can submit claims. If you file them later than the allowed time, you will be denied. For most major insurance companies, including Medicare and Medicaid, the filing limit is one year from the date of...
Dec 21, 2009 | Medical billing basics
M20 Missing/incomplete/invalid HCPCS.Check the CPT M29 Missing operative note/reportM30 Missing pathology report.M31 Missing radiology report. Resubmit the claims with Medical documents. M34 Claim lacks the CLIA certification number. Resubmit the claim with CLIA...
Dec 21, 2009 | Medical billing basics
B9 – Patient is enrolled in a Hospice. Bill with modifier QW or QV. Please see the below link for more information. Avoiding denial reason code PR B9 FAQ Q: We received a denial with claim adjustment reason code (CARC) PR B9. What steps can we take to avoid this...
Dec 21, 2009 | Medical billing basics
A1 Claim/Service denied. This is General code telling that cliam is denied. Look the additional code for more information. B1 Non-covered visits. This is non covered visit. Look the additional code for more information. B4 Late filing penalty. This is the amount...
Dec 17, 2009 | Medical billing basics
What is CHAMPVA? CHAMPVA is a health benefits program in which the Department of Veterans Affairs (VA) shares the cost of certain health care services and supplies with eligible beneficiaries (see Eligibility Fact Sheet 01-03 for criteria for CHAMPVA coverage)....
Dec 17, 2009 | Medical billing basics
What does CHAMPVA pay? In most cases, CHAMPVA pays equivalent to Medicare/TRlCARE rates. CHAMPVAhas an outpatient deductible ($50 per person up to $100 per family per calendar year)and a cost share of 25%. You should collect the 25% allowable cost share from...
Dec 17, 2009 | Medical billing basics
How do I get a claim paid? The HCFA-1500 should be sent to: VA Health Administration Center CHAMPVA PO Box 65024 Denver, CO 80206-9024 This is the only address that should be used for CHAMPVA claim submissions. If the beneficiary has other health insurance...
