THREE ISSUES HAVE BEEN IDENTIFIED WHICH HAVE CAUSED ERRONEOUS CLAIM DENIALS SINCE THE IMPLEMENTATION OF NEW PROGRAM POLICY. 1.CERTAIN MHR PROCEDURE CODES WERE INADVERTENTLY LOADED TO BE NON-PAYABLE ON DOS 7/31/05 AND DENIED 299.THE DATE ON THESE CODES HAS BEEN CORRECTED TO MAKE THEM NON-PAYAB...
Providers could expect to see denials on procedures that may have previously paid when billed in the same manner. For NCCI edits, the decision on which procedure code of a code pair is payable is determined by CMS. CMS updates these edits quarterly. DME providers may see new edit messages ...
Some states exclude or carve out drug benefits from their Medicaid managed care organization contracts, in which case, managed care beneficiaries receive their prescribed drugs through the fee-for-service delivery system, and states can claim manufacturer rebates for these purchases. 17. Testimony o...
If the service doesn’t meet the required standards—well, the AI is watching, and your claim could very well end up as “denied.” To avoid being sent down the proverbial rabbit hole of rejected claims, ensure your telehealth documentation is as robust as an in-person consultation, with ...
remind providers and submitters that the following Bill Type codes are the only codes that are acceptable for the Louisiana Medicaid Program, including Bayou Health claims and encounters. Thefile extension of the electronic claim fileis also very important in combination with the Bill Type codes. ...