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Wiki Modifying Original Claim with Primary and Secondary Payers

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lwojtowicz@pcpeds.com

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Is it okay to modify an original claim after sending to a primary payer and sending to a secondary? Example Commercial did not require a modifier but secondary does require a modifier. Is this okay to do?
 
Hi,

As long as it's payer specific requirement you are good to go with modifier on the secondary claim provided documentations support it. This is somewhat like secondary Medicare requires a specific Rev code w/ a cpt charge line item on original claim after commercial primary processed the claim. So yes, alteration is okay in that sense.

Thanks,
Manny
(Medicare institutional billing RTP specialist & investigator, CMS A/B expert, FI proficient, CPC)
 
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