Coding > Coding

760.71

<< < (2/2)

blhoffman:
I'm from PA and deal with PA Medicaid through out the day. I find that when I call with the claim number the reps. are really good at finding the problem and explaining to me why my claim is denying. If it is me or them.

They always call me back within the time frame they give me also. In my opinion, for what is worth, just call them and ask them why. They should research it and help you out. If you have a claim number for the claim that did pay, that is even better.

 

oneround:
I would also push the guidelines for late effects, section 1.B-12.  You code the residual first then the late effect.  As stated in the guidelines, late effects can occur MONTHS or even YEARS later. Also, make sure that the carrier is not trying to classify FAS as Acute because if they ae that may be the probelm   The ladies are correct there is no age restriction indicated, but the general rule is that FAS is determined at TOB because you can't determine the dx months or even years later.  I would make that call first as the ladies reccomend and if all else fails appeal with documentation and a copy of he late effect guidelines.  Nowdays , most all claims are pd automatically, no processor involved, the DX could be hitting an age restriction system edit which simply requires processor intervention.  You may also need the pt's maternal chart, diagnosing FAS, to support your appeal.  I'm going to run a mock scenario through our 3M system tomorow and see what edits I get.  I agee with Michelle, ths is a tough one to call.  Question, when you are billing are you linking both dx's to your CPT codes?  Just a thought

Anne:
thanks for all input.  I'm wondering if Medicaid is adding in more ways to suspend or deny claims that they used to auto. pay before, because I have several problems now that never had before.  We DO send in lots of documentation before billing, just to get authorization, but once auth is in place, it wasn't much of a problem getting payment, but now I have WAY more appeals, modifiers required, and some I do not know WHAT they are wanting.  It's getting worrisome.

Navigation

[0] Message Index

[*] Previous page