Wiki Payer Changing Submitted Codes

shellott

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Everett, Washington (20622)
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I am wondering if any one has experianced a Health Insurer applying payer discount or denying a submitted code and then addding and paying on a similar code.

Example: Pt. changed insurance late in the pregnancy and we billed the new insurer for the delivery and postpartum care only and they denied the 59410 and added 59400 to our claim and paid that code.

I am wondering if this occurs alot with OB/GYN claims due to payer policies and if this happens to other procedures as I deal with multiple specialties. Any thought would be appriciated. Thanks Shellott
 
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