Sunday, May 1, 2011

ESPDT CODE UPDATES FOR PHYSICIAN EXAMINATION SERVICES

DESCRIPTION OF THE ISSUE
We haven’t filed claims with N and NU ESPDT codes for physical examination procedures.  Hence we received denial stating “Invalid/need referral check codes”

CONCEPT
For Physical examination codes (99381-99395) we must enter Child Check up code “N” and its valid referral code “NU” in EPSDT fields for Medicaid insurance.

SOLUTION
Based on the denials received from Medicaid, we scrutinized the reason for the given denials and found per Medicaid rules to file Physical Examination codes along with N and NU ESPDT codes to have the claims reimbursed.  Hence the claims were refiled with the same and got reimbursement on the same.  Henceforth the rule was set towards the Charge entry executives file these procedures with ESPDT codes for Medicaid without fail.

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