Eli's Rehab Report
READER QUESTION ~ Submit Paper Claims on Time
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Submit Paper Claims on Time Question: Do you have any suggestions for filing paper claims for unlisted-procedure codes? Our payer has said that we are not in compliance with its "timely filing" requirements. Solution: File the claim electronically and then submit paper documentation separately. Be sure to include a note with the paper claim, explaining: "This is not a duplicate claim. This documentation supports an electronic claim." You can also note (in the electronic equivalent of box 19 on the electronic claim) some indication as to what unlisted services (such as 95999, Unlisted neurological or neuromuscular diagnostic procedure) you are submitting. Be sure to clarify that you're sending a hard copy of documentation separately. File the paper claim within the payer's allotted time frame, as well. Don't wait for the carrier to reject your electronic claim to file the paper claim. If you wait, your payer may say the electronic claim was incomplete and it didn't reset the clock for timely filing after receiving the electronic claim.
New York Subscriber
Answer: Many payers require electronic claims as proof of timely filing. But on many occasions, you must provide full documentation, so you should file a paper claim--such as when filing with unlisted-procedure codes or modifier 22 (Unusual procedural services), 52 (Reduced services) or 53 (Discontinued procedure).
Eli's Rehab Report
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