Wiki N.C. Mediciad Denial for preventive visits on children

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babocik95

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We just recently went to ECW and we cannot get reimbursed for preventive care visits on children. We are using the EP modifier with the CPt codes. our denial reason states attending provider not eligible on service dates. and B7=This provider was not certified/eligible to be paid for this procedure/service on this date of service. Example is 99392 EP with DX codes Z00.129 and Z23. Pt is four years old. Strange thing is we get paid for sick child visits under this provider. Can anyone please help not for sure if it is coding issue or problem with set up in ECW. Thanks in advance.

Barbara
 
Attending Provider

Did you call your provider representative to see if the attending provider was eligible on the DOS? Or perhaps the attending didn't re-certify (forgot)?

If you're getting payment for the same attending for the same DOS for different codes it sounds like a coding issue.

Either way I would call the provider help desk and ask for assistance.
 
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