Birdie625
Networker
Hi, if Ins (M'caid) denies a claim (in total) because 1-dx is not to their liking (unspecified location &/or laterality) and biller then removes the offending dx; resubmits; paid.
It just seems odd a biller can out-right remove a diagnosis, even tho that is part of the reason provider wanted test(s) done. And I strongly say provider(s) need to be taught about specificity/location/lat, etc.. These tests are ordered at a prior office visit then 'pended' until pt shows up to have them done (i.e. blood work for a f/up appt 6-mths later). I've been mind boggled and thought I would throw ? out. Thanks for any time.
It just seems odd a biller can out-right remove a diagnosis, even tho that is part of the reason provider wanted test(s) done. And I strongly say provider(s) need to be taught about specificity/location/lat, etc.. These tests are ordered at a prior office visit then 'pended' until pt shows up to have them done (i.e. blood work for a f/up appt 6-mths later). I've been mind boggled and thought I would throw ? out. Thanks for any time.