Question claim denials

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I work for an ASC and my claims are being denied for multiple reasons, but insurance company is paying the professional claim with no issue. My claim and the professional claim bill the exact same codes. I dont know how to fight this!! Please help
Thank you Chelsa T. CPC,CPB
 

Henson65

Networker
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Hi Chelsa,
It really depends on the specific reason for the denial....is the POS correct for the facility? Does the facility have contracts with the carriers they are billing? If you have a specific denial(s) I can help you work through what the issues might be....or sometimes just a call to the carrier will help you to understand what the issue(s) are.
 

vanessamoldovan

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Local Chapter Officer
NAB Member
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Des Plaines, IL
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I work for an ASC and my claims are being denied for multiple reasons, but insurance company is paying the professional claim with no issue. My claim and the professional claim bill the exact same codes. I dont know how to fight this!! Please help
Thank you Chelsa T. CPC,CPB
Chelsa, I would agree with the previous post, as well. There are multiple reasons that the charges for the professional services would get paid and the ASC wouldn't. Would you mind providing a sampling of the types of denials you are receiving?

Vanessa Moldovan, CPC, CPPM, CPMA, CPC-I
847-873-9231 (mobile)


AAPC- National Advisory Board Member 2018-2021
Region 5 - Southwest
 

skiboi

Networker
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Twin Falls, ID
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I agree with the other posts, but my first go to thing I look at is the POS, NPI on each claim, as I've gone through multiple EMR changes and that is always what is wrong.
It would be beneficial to see an example of what your getting in terms of the denial.
 
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