Author Topic: Cenpatico - Denial Code  (Read 5230 times)

PsychBiller

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Cenpatico - Denial Code
« on: March 06, 2014, 01:45:35 PM »

I am billing mental health claims to Cenpatico, we are in the state of Georgia.

All claims were successful until recently, and I am now getting denials which state:

DENY: NO STATE RATE FOR MODIFIERS SUBMITTED

I have not been able to find any solution to this, and my provider rep has not returned any of my calls.

Please can anyone offer me any guidance?

Michele

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Re: Cenpatico - Denial Code
« Reply #1 on: March 07, 2014, 03:54:19 PM »
Do you have any modifiers on the claim?  What codes are you billing?  When did the denials start, beginning of 2014?
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PsychBiller

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Re: Cenpatico - Denial Code
« Reply #2 on: March 10, 2014, 01:38:21 PM »

I am billing 1 unit of 90834, no modifiers and all claims paid up until 2.14.14 and are now denying for the previous reason stated.

PMRNC

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Re: Cenpatico - Denial Code
« Reply #3 on: March 10, 2014, 02:29:58 PM »
What kind of provider is this?
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Michele

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Re: Cenpatico - Denial Code
« Reply #4 on: March 10, 2014, 02:38:06 PM »
Just out of curiosity, are you billing on a CMS or a UB04?
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Re: Cenpatico - Denial Code
« Reply #4 on: March 10, 2014, 02:38:06 PM »

PsychBiller

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Re: Cenpatico - Denial Code
« Reply #5 on: March 10, 2014, 02:43:26 PM »

I am billing for a Ph.d, and billing on a CMS.

rdmoore2003

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Re: Cenpatico - Denial Code
« Reply #6 on: March 10, 2014, 07:42:48 PM »
I would call the claims dept.   I had an issue recently like this, and it was just a blimp in their system.

Michele

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Re: Cenpatico - Denial Code
« Reply #7 on: March 11, 2014, 09:58:18 AM »
I agree with rdmoore2003.  I looked on their website and there doesn't seem to be any new info.  I would call and ask them to explain the denial.  It may just be an internal issue.
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PsychBiller

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Re: Cenpatico - Denial Code
« Reply #8 on: March 11, 2014, 01:59:22 PM »

Finally I found a solution to this issue....YAY!!

Apparently the modifiers have been required since 7.1.13 but they only started denying claims effective 2.14.14.

I needed to add 2 modifiers to the claim, one that showed the doctors specialty (MD/Ph.D/Masters Level) and the other to show the location (in office/out of office).

Michele

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Re: Cenpatico - Denial Code
« Reply #9 on: March 11, 2014, 02:32:52 PM »
Awesome!
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Re: Cenpatico - Denial Code
« Reply #9 on: March 11, 2014, 02:32:52 PM »