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Denial for Documentation???

  1. #1
    Question Denial for Documentation???
    Medical Coding Books
    We have several payers that deny most of the claims we send them for documentation. The documentation is all sent with the claims. Some of the payers are part of Ohio's Workers Comp, which images the documentation they receive onto the website, so we even have proof that they received the documentation in many cases, but we still receive denials for documentation. I know the documentation isn't missing anything, because when I send the exact same thing to them a second time, they usually pay. I don't see any pattern other than these several payers do it frequently without regard to the patient or the service. What is going on with this, and does anyone know of anything I can do to make sure they aren't seperating the claims from their documentation?
    Lisa Keith, CPC

  2. #2
    Default I feel your pain
    I used to work in Ohio and remember vividly sending the same info over and over because they never received it.

    The only thing that ever worked with us was to get the provider rep from the insurance company involved. I don't know if BWC has that type of person though. My personal headache was with Nationwide Medicare and Anthem BC/BS, I didn't deal much with BWC. Generally when I did it was on an individual patient/problem and I would fax the info to a person at comp directly.

    Good luck,

    Laura, CPC

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    Some of our WC carriers became lazy processing our claims or mysteriously lost the medical record. After we started seeking the 10% penalty fee (and won), we saw this trend decrease.

    A: G.S. §97-18(i) states "If any bill for services rendered under G.S. §97-25 by any provider of health care is not paid within 60 days after it has been approved by the Commission and returned to the responsible party, or within 60 days after it was properly submitted, in accordance with the provisions of this Article, to an insurer or managed care organization responsible for direct reimbursement pursuant to G.S. §97-26(g), there shall be added to such unpaid bill an amount equal to ten per centum (10%) thereof, which shall be paid at the same time as, but in addition to, such medical bill, unless such late payment is excused by the Commission."

  4. #4
    Default
    Re: the 10% penalty fee...

    What state is that for?
    Lisa Keith, CPC

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    I'm in NC.

  6. #6
    Default
    hmmm I wonder if we have something like that?? where would I look?? optimum choice (unitedhealthcare hmo) is FAMOUS for pulling that stuff... drives me INSANE...

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