Friday, June 11, 2010

Claim denied as Invalid diagnosis code


Employer’s name and address is requested if the coverage is Workmen compensation, if the coverage of the patient/subscriber is through the employer, other than w/c cases. For the workmen compensation claims we need to give the information about employer as the coverage is through them.  There are other cases where the patient may have coverage through carrier.  Big corporations like General motors, Ford etc. provide medical coverage for their employees through health insurance carriers. By virtue of being an employee of this company, a person gets benefits of free medical coverage for him and his family.

    Action: If you get this denial, check the PD sheet for employer details. If the same is available but not entered in the system, then enter the details into the system. If no detail is available in PD then call the patient and get the details from him or from the employer if his phone# is available.


Workers Compensation provides disability income to employees who are unable to work due to an injury that occurred on the job. It is an insurance system for employees who have become ill or injured while at work. This plan covers only work related problems. Employees are eligible to receive a percentage of their wages and medical care depending on the time needed before they can work again and the extent of medical treatment needed.

If an employee gets high fever while at work and this is not due to his working condition it will not be covered under Workers Compensation, as the fever was not due to the nature of work.

Workers Compensation is funded by employer taxes; employees cannot be charged any premiums and there is no patient responsibility on these bills. Workers Compensation is required by the government but varies by state; each state has its own rules and regulations and fee schedule/UCR rates.

Workmen’s Compensation should not be confused with EGHP and LGHP. The EGHP and LGHP plans are a facility provided to the employees by employers to cover their medical expenses at a lower premium, whereas workmen’s compensation coverage is a coverage provided by employers in order to cover the employees medical expenses caused due to the nature of work.


Basically, no-fault insurance is what its name suggests: there’s no fault placed in the event of an accident. The drivers involved would submit a claim to their own insurance companies and receive compensation from them rather than target one another, trying to figure out who’s to blame.
No-fault insurance is not offered in every state. State governments govern it and so each state has its own coverage stipulations and regulations. States that offer No-fault insurance are called ‘No-Fault States’.

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