Wiki Claim Rejection

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shellnerob

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Raleigh, NC
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I've received this additional information as reason for rejection of a claim. CATEGORY- ACKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE CLAIM-THE CLAIM/ENCOUNTER HAS BEEN REJECTED AND HAS NOT BEEN ENTERED INTO THE ADJUDICATION SYSTEM. STATUS- MEDICAL REVIEW ATTACHMENT/INFORMATION FOR SERVICE(S) Does anyone have ideas for where I start with sending this claim? The patient was seen in a hospital by one of our ENT doctors.
 
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I believe it means it was rejected, not denied. A corrected claim should not be required. I would check the place of service indicator and review the E/M codes to make sure they align with hospital codes.
 
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Did you try to submit an attachment with a first time claim submission? Or, does the type of claim require an attachment? Does box 19 state something is attached when it is not? Is it an unlisted code? Did you try to google/search this "MEDICAL REVIEW ATTACHMENT/INFORMATION FOR SERVICE(S)" and what the rejection means in your clearinghouse? Is there a code or rejection type along with that? Did a coder double check the coding and charges, etc. on it? Does the demographic information match the insurance card/policy and everything is correct?

This is the clue:
MEDICAL REVIEW ATTACHMENT/INFORMATION FOR SERVICE(S)
 
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Thank you. There is an attachment that has been submitted with the claim. I will ask coder to verify coding and charges. I appreciate all the suggestions and your help.
 
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