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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.

    Thanks,
    Nick

  2. #2
    Location
    Austin, Texas
    Posts
    467
    Default
    http://www.cms.gov/Medicare/Provider...yCrosswalk.pdf

    http://www.cms.gov/Regulations-and-G...ds/R2842CP.pdf

    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.
    Nick

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