Author Topic: Condition code on UB92 Form  (Read 1366 times)

Alice Scott

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Condition code on UB92 Form
« on: March 02, 2008, 06:41:38 AM »
Question
I hope you can help me.  We have always sent our UB92s for our Ambulatory Surgery Center on paper claims.  We are trying to convert to sending them electronically.  They are not being accepted by the clearing house because there is no condition code on the claim.  We have never put a condition code on the paper claims and have always received payment.  We are an ophthalmology practice that routinely bills for cataract surgeries.  I have purchased the Uniform Billing Editor and have reviewed the condition codes and do not see one that seems to apply to us.  Can you please help me?
Thanks,
Cindy

Answer
Hi Cindy,
I also looked at all the condition codes and don't see one applicable.  I have never personally been required to complete that field either on my paper claims or my electronics.  There must be a code that you can automatically put into the electronic claims to get them to go thru that actually won't affect the billing.  I would contact the support line for the clearing house that you are using and ask them.  Often there are requirements by the clearing house that the insurance carriers don't necessarily set.  They certainly should be able to tell you what you can use to get the claims thru.  Explain to them that you don't need a condition code on the claim and that there is no appropriate code that you can use.
There are obviously other providers that use the clearing house with the same issue and they must have a generic value you can enter.
Do you go directly to a clearing house or do you have a vendor?  If you have a vendor, you should contact them first.  They will be more helpful.  If you don't get anywhere, email me back with more specifics.  What state are you in?  What clearing house, etc.
Good luck,
Michele
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