Medical Billing Forum

Payments => Insurance Payments => Topic started by: Tilbrook on August 23, 2010, 09:44:30 AM

Title: Medicaid Denials
Post by: Tilbrook on August 23, 2010, 09:44:30 AM
Hi All,

I found this forum a few weeks ago and am finding it so helpful!  I started a medical billing business over a year ago and finally have two clients.  I am specializing in mental health billing, as I am also a social worker.  My new client is having me try to clean up some of her old claims.  I set up electronic billing for Medicaid through my software, DAQBilling and set through my first round of old Medicaid claims.  The remittance just came back and there are several error codes that I have never seen before.  Does anyone know what these codes mean and/or what I can do about them to get them paid?

00218: Procedure code invalid for provider category of service
01164: Recipient not QMB; SVCS not reimburseable for enrollment COS
00901: Claim type could not be derived using submitted information.

Thanks in advance!
Tilbrook Healthcare Billing, LLC
Title: Re: Medicaid Denials
Post by: Michele on August 24, 2010, 09:16:47 PM
Well, the first one is saying that the procedure code that you are billing is not ok for the type of provider you are billing for.  If you feel it is, then you should call Medicaid and ask them to explain.  The second one is stating that the patient is not eligible for full Medicaid benefits.  And the third one is indicating that something important was missing on the claim.  You need to call Medicaid and ask them what it was.  Basically all three can be explained by a Medicaid rep.  I would call Medicaid.

Title: Re: Medicaid Denials
Post by: Tilbrook on August 24, 2010, 09:27:50 PM
Thank you so much Michele!  I will call Medicaid tomorrow to get more information.