Author Topic: Help?  (Read 828 times)

jjohnson72

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Help?
« on: September 30, 2016, 03:16:24 PM »
I am new at "claim chasing", have only been doing this for a few months with little training. Is this a place that I can ask questions? I just need help on some denial codes and what the next step should be. I want to make sure that I don't miss anything.

jjohnson72

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Re: Help?
« Reply #1 on: September 30, 2016, 03:22:51 PM »
For example: I am in Colorado and received a UMR denial that states: 45 - Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Yet when I go to the website, it shows as a provider discount and patient owes nothing. I know that is not an acceptable answer but am unable to figure out where to go from here....

Michele

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Re: Help?
« Reply #2 on: October 01, 2016, 06:22:02 AM »
The 45 - Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement is not a denial.  It is a message code that indicates that the amount billed is more than the allowed amount for the procedure.   Was any payment made?  Or was the allowed amount applied to the deductible or a copay?  Were there any other message codes on the claim?

You can ask for this kind of help on this forum.  The more specific you are the better able to answer we are.  :)   Just remember never to provide any PHI!
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PMRNC

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Re: Help?
« Reply #3 on: October 01, 2016, 04:30:53 PM »
Michele is correct.. either the amount you billed was OVER the fee schedule (NOT patient responsibility) or if you are NON par the amount was above U&C to which the patient WOULD be responsible.
Linda Walker
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