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CynthiaCurren

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I am having issues and do not agree with employer.
Cigna paid 59400, secondary Medicaid has denied for missing modifier (GB, greater than 39 weeks, informational only).
My interpretation is that we would need to follow EOB for balance or send appeal to Medicaid regarding coded correctly per primary insurance.
Or add the GB and submit corrected claim. And wait for processing, but if we do this could possibly get denial for incorrect modifier use and ask for recoup from Cigna, or it could be fine.
Second issue is Medicaid does not pay for global delivery charges anyways in Louisiana so they would deny for 59400-GB also.

My employer is directing me to ask AR to drop this to paper and add the GB modifier to 59400 and submit by paper to SECONDARY only.

Is this correct? I don't agree.
 
Your employer likely wants the claim resubmitted so that the final denial from the secondary shows a non-covered service, rather than a billing error for a missing/invalid modifier. Because Cigna does not require the GB modifier but the secondary does and it's informational only, I don't see a problem with adding the GB modifier and submitting a corrected claim only to the secondary payer.

Interested to see what others think on this topic :)
 
While I typically do not change a claim when submitting to secondary, I would have no issue submitting to secondary adding an informational modifier. Coding changes beyond that, I would appeal to secondary.
 
CynthiaCurren said:
I am having issues and do not agree with employer.
Cigna paid 59400, secondary Medicaid has denied for missing modifier (GB, greater than 39 weeks, informational only).
My interpretation is that we would need to follow EOB for balance or send appeal to Medicaid regarding coded correctly per primary insurance.
Or add the GB and submit corrected claim. And wait for processing, but if we do this could possibly get denial for incorrect modifier use and ask for recoup from Cigna, or it could be fine.
Second issue is Medicaid does not pay for global delivery charges anyways in Louisiana so they would deny for 59400-GB also.

My employer is directing me to ask AR to drop this to paper and add the GB modifier to 59400 and submit by paper to SECONDARY only.

Is this correct? I don't agree.
Click to expand...
 
Do you have the ability to login and enter claim to Medicaid? I would drop to paper attach Cigna job and add the modifier, for documentation purposes so you can at least get a denial to apply to account.
 
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