Optometry Coding & Billing Alert

Published on Sun Jan 08, 2006 PDF

Question: Do I have to file an appeal every time I make a mistake on a claim? Are there any other options? I heard there were some new rules regarding this.


Maine Subscriber

Answer: Optometry offices may not need to file an appeal to correct a claim if the mistake is deemed -minor,- according to new rules from CMS.

When an office commits a minor error on a claim, the biller can ask the carrier to reopen the claim so she can correct the problem -- entirely avoiding the appeal process. With most carriers, minor errors will include basic typographical and clerical errors.

Try this: If you get a denial from an insurer that contains a minor error, follow these three steps to determine if you can fix the error without appealing:

Check the provider manual: It tells you how to appeal certain types of errors, and you should follow those directions exactly if the manual addresses your specific problem.

Check recent carrier bulletins and communiques: Often, these announcements contain information about processing problems the carrier is having. If the carrier is having a problem, the bulletin will tell you how to handle the reprocessing.

Call the carrier: If your appeal contains a minor error that is not covered in the provider manual or carrier bulletins, pick up the phone. Explain your troubles to the carrier representative, and the rep will tell you how to handle the correction without appealing.