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cleanclaims

Networker
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Manchester, TN
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Did you know that Colorado has legislation that will require all insurance carriers to follow the same guidelines for submission of claims? In addition, all edits can be referenced on where they came from. (National carriers and vendors are represented on our task force including UHC, CIGNA, Wellpoint, Kaiser, McKesson, Optum Insight, AMA)

Here is one example already agreed upon by all:

All carriers will use modifier 50 to indicate a bilateral procedure (no RT and LT on 2 lines; no 1 line with 2 units etc)

Here's one decision tree in the process of being voted upon:

Assistant at surgery: (ACS = American College of Surgeons)

1. If the ACS indicator for assistant at surgery is ALWAYS or NEVER we will accept the ACS edit as our edit
2. If the ACS indicator is SOMETIMES and the CMS indicator is ALWAYS or NEVER we will accept the CMS edit as our edit.
3. If both the ACS and CMS indicators are SOMETIMES then we will default our edit to NEVER.
ANY ASSISTANT SURGERY DENIAL IS APPEALABLE BASED ON MEDICAL NECESSITY.

If you are interested in getting updates on this developing information please e-mail me and I will add you to the list. (I promised not to drive you crazy with constant e-mails, but only pertinent updates)

swaahealy@msn.com
 
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