Monday, June 14, 2010

Insurance denial - Invalid procedure code


    Action: Check the charge sheet as to whether the rejection is due to wrong keying in at the time of charge entry. If yes, then correct code to be use. If not, check if the code used is correct with Encode pro, CCI Edits & LMRP.  If we have used a wrong code,  then goahead and change it and re-file the claim.  If no then there is one more reason for getting this type of rejection, the carrier may not be paying for some codes. In such cases we have to call the carrier and if the carrier says that they do not pay for the procedure than the amount has to be written off. There are cases where the primary may not be paying for one code whereas the secondary may consider the same. Medicare won’t pay for denial procedures whereas a secondary commercial may pay for the same.  In such cases submit the claim to the secondary insurance.


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