Correcting a claim - again!

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drk
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Correcting a claim - again!

Post by drk » Wed Jun 10, 2015 9:50 am

How do I change the diagnosis codes for a rejected claim? I have posted the 835 and the 13 digit ICN shows up on the claim comment field.

Do I have to create a new case with the correct diagnosis codes, copy all the transactions lines for the rejected claim, copy the ICN manually, change claim frequency to 7 (replace prior claim), and populate the original reference number under the Medicaid tab?

Or is there another way?

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Gavin Walker
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Re: Correcting a claim - again!

Post by Gavin Walker » Wed Jun 10, 2015 12:48 pm

I think you are making this way more complicated than it needs to be. What was the reason for rejection? Duplicate claim? Invalid diagnosis code?
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drk
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Re: Correcting a claim - again!

Post by drk » Wed Jun 10, 2015 12:49 pm

Invalid diagnosis code(s)

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Gavin Walker
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Re: Correcting a claim - again!

Post by Gavin Walker » Wed Jun 10, 2015 1:12 pm

If you correct the diagnosis on the case, from then on, any new transaction lines entered under that case will default to the new diagnosis codes. You will also want to change the diagnosis codes and pointers for each charge on the claim. Once you have done that, change claim status 1 back to Ready to Send and the claim will go out with the next batch of claims.

You only need to send a corrected claim if the claim was accepted, but there was something wrong with the original claim.

drk
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Re: Correcting a claim - again!

Post by drk » Wed Jun 10, 2015 1:24 pm

Yes, I am talking about the latter situation - The payer denied a claim for missing a particular diagnosis code or it not being the primary diagnosis. So, the claim already has a payer claim number (original reference number) as well as an ICN in Medisoft comment.

This claim now needs to be resubmitted as a replacement claim with new/reordered diagnosis codes and the ICN of the original claim. I would rather not create a new case, if at all possible.

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Gavin Walker
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Re: Correcting a claim - again!

Post by Gavin Walker » Wed Jun 10, 2015 10:10 pm

Then in addition, just do the steps that you stated, but you can do it on the existing case and claim. :)

drk
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Re: Correcting a claim - again!

Post by drk » Thu Jun 11, 2015 2:59 pm

Do it on the existing case - yes, existing claim - no. When you delete the diagnoses and enter new ones, the (old) claim lines get deleted -- So, here is a workaround - please critique -- Post the EOB, mark the old claim done, create identical new procedure lines below it with the correct diagnosis codes. This will retain the case information like you suggest and I will get my new claim (while keeping the old one for history).

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Gavin Walker
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Re: Correcting a claim - again!

Post by Gavin Walker » Thu Jun 11, 2015 4:58 pm

Ah yes. Changing the diagnosis code causes the charge to be removed from the claim. So, go ahead and delete the claim to release any other charges that were on that claim.

Next, was a payment applied to any of these charges and the insurance was marked Complete? If so, go back into Apply Payment and un-check the complete box.

Now, when claims are created again, the charges should go onto a new claim that will be ready to be billed again. Then mark the claim as a corrected claim.

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