Medical Billing Forum

Billing => Billing => : carnilent July 18, 2009, 09:15:22 PM

: making an error on a claim - using the wrong modifier
: carnilent July 18, 2009, 09:15:22 PM

Hi everyone;    I've been really busy with my new client.   I recently billed a claim on a patient for which the Dr. performed a special test called ANSAR (  new test )   I billed the claim with the correct cpt codes for the test but I  accidently put modifier 59  instead of 25.    and billed pos as 21 instead of 11.

I think I will have to wait for a denial? before I can resubmit?   Or can I call the the ins. company and resolve it over the phone?    it's BC of fl.

thanks for all your help!!!

carnilent

: Re: making an error on a claim - using the wrong modifier
: Michele July 18, 2009, 10:26:42 PM

Most insurance companies require that you wait for the claim to be processed.  I would call though, maybe the claim is not on file, or was denied, but you didn't receive the eob yet.  It's worth calling to check on.

Michele

: Re: making an error on a claim - using the wrong modifier
: PMRNC July 19, 2009, 12:34:10 PM

If you know there is an error you should always send a corrected claim right away. If your electronic claim submission allows for notes you can put "corrected" claim on it.  Sometimes I just stamp the claim "Corrected Claim", add a letter explaining the error in case the claim is processed in the interim.
 

: Re: making an error on a claim - using the wrong modifier
: carnilent July 19, 2009, 04:48:49 PM

won't the ins company deny the claim as a duplicate?


thanx for the help

: Re: making an error on a claim - using the wrong modifier
: PMRNC July 19, 2009, 04:52:37 PM

They might, which is why I recommend a paper claim with a letter attached and stamping the claim "Corrected Claim". We used to have a separate drop off for those claims when I was a claims examiner. The standard procedure was to pull the previous claim, if payment was sent out they will request a refund, and create an adjusted claim. The reason I say not to wait is so you don't get the letter asking for the money back and have to wait longer. I also usually will call and tell them I'm submitting a corrected claim and they will sometimes go pull it and put it in pending status for the corrected claim.

: Re: making an error on a claim - using the wrong modifier
: carnilent July 19, 2009, 05:13:13 PM

thank you I will do that.


carnilent