Author Topic: Medicare - CO151 - Payment adjusted because the payer deems the information  (Read 23501 times)

aiken2017

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Hi, I am having a similar problem with Medicaid as primary cpt code  99213 and denial CO151  no remarks.    this is the first visit in over an year.  I look at the units and is just 1 unit so definitely is not an unit issue.   does anybody knows what could be the problem? for some reason with Medicaid I get a lot of denials that do not happen with other payers including Medicare.  we are locate in South Carolina so I verified the LCD before asking and is not a problem either :(

Michele

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I'm not familiar with SC Medicaid but in NY they have a certain number of visits they can have in a year.  If they go over that number the provider must complete a Threshhold override form to request additional visits.  It sounds like it might be that.
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aiken2017

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Thank you so much Michelle. They finally reach out to me.   The problem was that we have the incorrect carrier code under the claims. So everything look like a completely different denial when in reality was something as simple as correcting the 3 digits carrier code. :)   oh boy.   

Michele

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That is unfortunately common to receive a denial that is completely different than the real reason. 
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PMRNC

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The advise by Sriram_Sub is NOT advice I would follow. I'm upset that other's have not broached this subject.
Do not ever take advice from a coder or entity that is based offshore.
Linda Walker
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Stistetry

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Re: Medicare - CO151 - Payment adjusted because the payer deems the information
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Re: Medicare - CO151 - Payment adjusted because the payer deems the information
« Reply #20 on: September 18, 2022, 03:56:14 AM »