Results 1 to 3 of 3

Provider's Primary Specialty

  1. Default Provider's Primary Specialty
    Medical Coding Books
    I just had a claim sent back to me saying that I need to resubmit with the "Provider's Primary Specialty". I called United Health Care about this and the lady I spoke to had no idea what that was about, because this was before the claim had officially gotten into there system she was unable to look at the claim to see the problem. She said that someone would contact me within 15 business days.

    Is there somewhere on the CMS-1500 that this is supposed to go? I have submitted several claims to them before with no incident.


  2. #2
    Austin, Texas

    The auto adjudication system is conflicting with the NPI number on the claim which may be telling the computer a pediatrician is performing open heart surgery...or perhaps the Group NPI was entered instead of the performing provider. The above links can help you research the problem...but don't rely on a call back from the carrier as it appears the claim may not have passed the clearinghouse.
    Marcus Murphy, CPPM

  3. Default
    Thanks Marcus, I will look into this. The NPI number is automatically populated into the form. It is for my wife's midwifery practice, she is the only provider and only has one NPI number. The strange thing is that I have submitted the exact same thing to them 3-4 times already with no incident.

    I will read these links to see if I can find out anything in there.

    Thanks again, I appreciate the help on this.

Similar Threads

  1. ED services by EM specialty code and OBS/ Admission by IM/EM specialty code
    By sauls in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 09-04-2015, 08:46 AM
  2. can the rendering provider and referring provider be same
    By arunp_001 in forum Medicare Regulations
    Replies: 2
    Last Post: 03-02-2013, 01:15 PM
  3. Actual Provider Vs Billing Provider
    By YesicaRuedas in forum Billing/Reimbursement
    Replies: 1
    Last Post: 02-27-2013, 04:02 PM
  4. Primary Dx
    By natraj21 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-25-2013, 03:34 PM
  5. Replies: 1
    Last Post: 03-30-2009, 02:55 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.