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Payer stating change the order of icd10 on ltc/snf

J

jenncode

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Here in Chicago a medicaid payer is telling us to change the order of ICD10 to receive payment. My argument is that their system is not setup for Aftercare to post acute/snf/ltc. Being we have to obtain a authorization. I have made this a level up from their regular claims adjuster. Please help!
 
So are you saying that if you change the order to what they are requesting they will pay it?

Or is it that you will need to obtain prior authorization if you switch it to the order they are requesting?

I have had experiences with "overzealous" Claim Representatives requesting things out of the blue. No matter how many time you point out that you've had these issues before and you never had to provide "X" they are relentless regarding whatever they are requesting. I always "played the game" and provided what was requested. Sure, it doesn't seem right but my provider doesn't care if I am "right" he cares if I am getting his claims paid.

Very often you will get two different answers from two different Claims Representatives, so hopefully you will get a different answer from the next Representative. Or you can request the authorization from them at least! ;)

(this is just my humble opinion)
 
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