Medical Billing Forum
Billing => Billing => : PsychBiller March 06, 2014, 01:45:35 PM
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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?
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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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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.
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What kind of provider is this?
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Just out of curiosity, are you billing on a CMS or a UB04?
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I am billing for a Ph.d, and billing on a CMS.
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I would call the claims dept. I had an issue recently like this, and it was just a blimp in their system.
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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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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).
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Awesome!