Wiki 835 Healthcare Policy Identification Segment

[vmounce]

I have a claim that denied for not deemed medically necessary, and to refer to 835 Healthcare Policy Identification Segment. I have never seen one of these before. Does anyone know what it means? Doc removed 2 lesions, one on each eyelid. Used 216.1, 11442 LT and 11441 RT.

I appreciate any info...

Vickie Mounce

 

[jkirasich]

We have been wondering the same thing. Has anyone else encountered this mysterious denial? Upon researching it looks as though it is the name of a list of denial codes, but I can't seem to find any other information.

 

[QueensCoder]

Mysterious denial

" Refer to the 835 REF Segment: Healthcare Policy Identification, if pr"


It seems that the denial explanation its truncated and we don't see the whole explanation. ...... I think that is what they want to say ....not medically necessary???? I thought that you can say that when behind your last name you write M.D. Who determines that?

 

[smiffer]

just got off the phone with medicare about the same denial, rep stated that it was submitted incorrect. if a medicare recipient has disability the claim needs to go through with a 43 code and not 47 code which is a liability code. It may be different in each state so give medicare a call.