Wiki Insurance Denial Question

[ammontagano]

Pt has Medicare primary and Cigna seceondary, code denied from Medicare as not medically necessary, we have ABN on file, claim sent to secondary and secondary denied as inclusive to the office visit. My question is...which insurance EOB should be followed? Do we push the balance to pt per Medicare or adjust off as inclusive per Cigna?

 

[Stefanie]

What was the procedure. Cigna is notorious for denying claims erroneously and you should see if this is one of them. I would appeal it unless CCI says they are inclusive and in that case you would think Medicare would have also denied as inclusive. I wouldn't right anything off yet.

 

[mitchellde]

I agree you need to assess the denial first from both Medicare and cigna. What were the dx codes and procedure codes billed.