Procedure code sets 2, 3

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dleto
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Procedure code sets 2, 3

Post by dleto » Mon Apr 30, 2018 2:54 pm

We have insurance carriers set up with procedure code sets 2 or 3, and have added those codes into the alternate codes in the procedure code. But when we bill the claim is using code set 1.

For example - we have a carrier set up as code set 2.
we have Procedure code 93975, has code set 2 as 93976.
When we enter the transaction for this carrier we entered 93975, when we create the claim it has 93975. not 93976.

Is there something else we need to do for this to work?

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Gavin Walker
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Re: Procedure code sets 2, 3

Post by Gavin Walker » Mon Apr 30, 2018 5:40 pm

Hmm, are you sending the claims electronically using Revenue Management or are these printed on paper? If Revenue Management, which iGuide are you using? If Paper, which Claim Report template are you printing with?
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dleto
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Re: Procedure code sets 2, 3

Post by dleto » Fri May 25, 2018 1:44 pm

we are using revenue management - iguide for transactions is 837 P MS19 5010 Claims.

It happens with paper and electronic - paper we are using CMS - 1500 Primary 02/12 w/ form

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Gavin Walker
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Re: Procedure code sets 2, 3

Post by Gavin Walker » Mon May 28, 2018 5:24 pm

Sounds like you have it all setup correct. So when you print the claim out or send it electronically, it has procedure code 93975 on it instead on 93976.

dleto
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Re: Procedure code sets 2, 3

Post by dleto » Tue May 29, 2018 10:12 am

yes

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Gavin Walker
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Re: Procedure code sets 2, 3

Post by Gavin Walker » Wed May 30, 2018 8:02 am

Is this a primary or secondary insurance and is this a primary or secondary claim?

dleto
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Re: Procedure code sets 2, 3

Post by dleto » Thu May 31, 2018 3:08 pm

primary insurance and claim

dleto
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Re: Procedure code sets 2, 3

Post by dleto » Tue Jul 03, 2018 11:01 am

Hi never got a reply to the last post when I answered your question as to whether it was primary or secondary. Do you have any ideas why this is not working or how to fix it?

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Gavin Walker
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Re: Procedure code sets 2, 3

Post by Gavin Walker » Thu Jul 05, 2018 11:57 am

Sounds like you have it all setup correct. Someone will probably need to work one-on-one with you. What clearinghouse are you guys using?

dleto
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Re: Procedure code sets 2, 3

Post by dleto » Tue Jul 17, 2018 2:42 pm

MD on line / Ability is the clearinghouse. Shouldn't the claim be created correctly before we send it to the clearinghouse, in claims management?

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