Wiki Claim Shouldn't Have Been Created/Sent

[RaveenaS]

Hello! I am new to the billing/coding world, about six months now. I have some unpaid claims that I'm reviewing and some claims should not have been sent because they are not supported for coding.
What is the next best step when realizing the claim should not have been created to begin with, but has been and has been sent to insurance for processing and has been denied?

The one in question right now is a MCR claim, and is over a year old from the service date of 10.08.2020.
I would like feedback on claims that get created mistakenly recently and for unpaid claims that are being viewed after months have passed.

Thank you in advance for any advice! =)
Raveena S.

 

[ccallycat]

Good news is that they denied, so no refund issues. I'll zero out charges, place a note on the line item stating it was billed incorrectly and never should have been sent (I keep trail/notes to cover myself). Then I'll call the insurances up and request that the claim be voided as "billed in error by provider" again put note in line item with call ref#. Sometimes they wont do it over the phone which is a pain and I'll send a letter. I keep a copy of letter scanned to show that I tried to rectify the situation. Just keep everything documented. With Medicare, if you have access to Novitasphere there is an option for Billed in Error. I'm not sure if they denied the claim if you'll still will be able to use that option. If it doesnt let you, you might be able to speak to a representative to ask if its actually necessary. On the side note, what I do might be overkill, but I just like to cover my self so no one can come back later and question why I didnt do anything about it.

 

[psd]

You have the option to submit "Void" claims electronically. You will need to find where to enter this information within your software, but in box 22 on the HCFA form you would enter 8 in the Resubmission code box, and your original claim number in the Original Reference number box. You don't have to change anything else on the claim, and the service will be reversed on the payer's end. If a payment was made, they will either offset the monies on a future payment or issue a refund request.
A word of advice on this - do NOT submit a void claim if you have ANY valid charges for this date of service, on a second claim or otherwise. Some carriers will void literally everything. If you need to simply correct something, you would enter a 7 in the Resubmission code box with your original claim number.

 

[RaveenaS]

Good news is that they denied, so no refund issues. I'll zero out charges, place a note on the line item stating it was billed incorrectly and never should have been sent (I keep trail/notes to cover myself). Then I'll call the insurances up and request that the claim be voided as "billed in error by provider" again put note in line item with call ref#. Sometimes they wont do it over the phone which is a pain and I'll send a letter. I keep a copy of letter scanned to show that I tried to rectify the situation. Just keep everything documented. With Medicare, if you have access to Novitasphere there is an option for Billed in Error. I'm not sure if they denied the claim if you'll still will be able to use that option. If it doesnt let you, you might be able to speak to a representative to ask if its actually necessary. On the side note, what I do might be overkill, but I just like to cover my self so no one can come back later and question why I didnt do anything about it.

Thank you so much! I'll definitely keep everything documented in case it does come back. I appreciate your feedback!

 

[RaveenaS]

You have the option to submit "Void" claims electronically. You will need to find where to enter this information within your software, but in box 22 on the HCFA form you would enter 8 in the Resubmission code box, and your original claim number in the Original Reference number box. You don't have to change anything else on the claim, and the service will be reversed on the payer's end. If a payment was made, they will either offset the monies on a future payment or issue a refund request.
A word of advice on this - do NOT submit a void claim if you have ANY valid charges for this date of service, on a second claim or otherwise. Some carriers will void literally everything. If you need to simply correct something, you would enter a 7 in the Resubmission code box with your original claim number.

That's great to know on submitting a "void" claim, I never knew that was an option. Thank you so much for your input!