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1/ August 2008 Resolution to Common Claim Denials Presented by EDS Provider Relations Field Consultants Insert photo here.

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Presentation on theme: "1/ August 2008 Resolution to Common Claim Denials Presented by EDS Provider Relations Field Consultants Insert photo here."— Presentation transcript:

1 1/ August 2008 Resolution to Common Claim Denials Presented by EDS Provider Relations Field Consultants Insert photo here

2 2/ August 2008 Resolution To Common Claim Denials Agenda Session Objectives Live Demonstration-Void/Copy/Replace Claims Claim Examples –Transportation –Hospice –Dental –Inpatient –Physician –Long Term Care Facility –Crossover Avenues of Resolution Questions

3 3/ August 2008 Resolution To Common Claim Denials Session Objectives Build a working knowledge of the Void, Copy and Replace functions Provide helpful hints on how to research denied claims and replace them –Reduce aged accounts –Maximize cash flow

4 4/ August 2008 Resolution To Common Claim Denials Copy/Void/Replace Location

5 5/ August 2008 Resolution To Common Claim Denials Transportation Claim-Round Trip billed as One Way Trip Problem: Provider billed a one-way trip –T2003 RP1 unit/$10 –A0425 U3, RP28 units/$35 Provider intended to bill a round trip –T2003 RP, PR2 units/$20 –A0425 U3, RP, PR 56 units/$70 Resolution: Click on Replace This Claim button Total units of the base code should be indicated on detail line one. Total unit of mileage indicated on second detail line. Two runs on the same day and all round trips should all be submitted on the same claim form.

6 6/ August 2008 Resolution To Common Claim Denials Hospice Claim-Invalid Diagnosis Problem: Claim submitted with invalid diagnosis code of 1850 Error Code 4040-Primary Diagnosis Code not on File Correct diagnosis is 185 Resolution: Replace claim with correct diagnosis

7 7/ August 2008 Resolution To Common Claim Denials Dental Claim-Incorrect Charges Problem: Provider submitted claim with old rates –Line 2-D9230Charge-$30Paid-$30 –Line 3-D2930Charge-$142Paid-$142 –Line 4-D3220Charge-$98Paid-$98 Resolution: Provider intended to bill with new rates –Line 2-D9230Charge-$32Paid-$30.95 –Line 3-D2930Charge-$158Paid-$ –Line 4-D3220Charge-$108Paid-$ –Replace claim with new charges –Result is $21.92 more in reimbursement

8 8/ August 2008 Resolution To Common Claim Denials Physician Claim-Incorrect and Omitted Procedure Code Problem: Provider billed – RT1 unit/$145 Provider intended to bill – LT1 unit/$145 – unit/$1,167 Resolution: Replace claim with corrected information –Correct the modifier –Add second detail line

9 9/ August 2008 Resolution To Common Claim Denials Inpatient Claim-Incorrect Covered Days Problem: Provider billed dates 9/14/07 to 9/25/07 in the Statement Covers Period (11 covered days) Provider incorrectly indicated 12 covered days in the Covered Days field Error Code 0518-Covered Days Exceeds Statement Period Resolution: Replace claim Correct the Covered Days to 11 days

10 10/ August 2008 Resolution To Common Claim Denials Inpatient Claim-Billed as One Claim Instead of Separate Claim for Acute and Psychiatric Problem: Provider billed one claim from 7/29/06 to 8/14/06 (16 covered days) Providers reimbursement did not include the per diem days for psychiatric level of care Resolution: Provider should have billed two separate claims –Acute stay from 7/29/06 to 8/6/06 (8 days) –Psychiatric stay from 8/7/06 to 8/14/06 (7 days) Copy claim and correct the acute stay Copy claim again and correct the psychiatric stay

11 11/ August 2008 Resolution To Common Claim Denials Long Term Care Claim-Patient Status Indicates Discharge Problem: Provider submitted claim with Patient Status 01-Discharged To Home or Self Care Error code 0522-Patient Status Indicates Discharge No Discharge Occurrence Code or Discharge Occurrence Date present on claim Resolution: Replace claim with –Occurrence Code - 51 –Occurrence Date – 06/15/08

12 12/ August 2008 Resolution To Common Claim Denials Dental Claim-Duplicate Claim Results in Over Payment Problem: Provider submits claim with all three lines paid Provider inadvertently submits same claim a second time Detail lines 1 and 3 deny correctly as duplicates Detail line 2 pays a second time because it is D0272-Bitewings Resolution: Void second claim so duplicate payment will be recouped

13 13/ August 2008 Resolution To Common Claim Denials Physician Crossover (Vision) Claim-Medicare Denied Detail Problem: Automatic crossover claim pays detail lines 1 and 3 because they are covered by Medicare Detail line 2 (92015) is denied because not covered by Medicare Error code 0593-At Least One Detail Contains Medicare EOB Data Resolution: Submit new claim for detail line 2 (92015) It is not necessary to submit a Medicare Remittance Notice (MRN), since is a program excluded code for Medicare

14 14/ August 2008 Resolution To Common Claim Denials Avenues of Resolution IHCP Web site at IHCP Provider Manual (Web, CD-ROM, or paper) Hospice Provider Manual Customer Assistance – , or –(317) in the Indianapolis local area Written Correspondence –P.O. Box 7263 Indianapolis, IN Provider Relations Field Consultant

15 15/ August 2008 EDS 950 N. Meridian Street, Ste Indianapolis, IN EDS and the EDS logo are registered trademarks of Electronic Data Systems Corporation. EDS is an equal opportunity employer and values the diversity of its people. © 2007 Electronic Data Systems Corporation. All rights reserved.


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