Tuesday, June 22, 2010

Insurance denial - Incorrect CARRIER


The claim was submitted to the incorrect payer/contractor for payment.


It's important to screen patients and be aware of the types of services provided prior to submitting a claim to the carrier. Check the patient's Medicare card and verify the Health Insurance Claim (HIC) number on the card. Patients with traditional Medicare coverage will have HICs of nine digits followed by an alphanumeric suffix. Patients who have railroad retirement (a type of federal health care coverage) will have HICs with an alpha prefix followed by either six or nine digits. Verify whether a Medicare-replacement Health Maintenance Organization (HMO) covers the patient. You can obtain this information by calling the Provider Service department, or online via your carrier's Web site. Additionally, pay special attention to whether you have provided refractive services and are submitting a refractive claim with a refractive diagnosis to the refractive carrier, or whether you have provided medical eye care services and are submitting a medical claim to the medical carrier. If you are not a contracted provider for a carrier, always collect from the patient in full for all services and materials you provide. Help the patient get reimbursed for your services by offering to fill out and submit the claim on his or her behalf, but don't accept financial liability for a claim that a carrier has no legal obligation to pay.

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