Secondary Claim Denials
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Secondary Claim Denials
Adjustment reason code (loop 2430, CAS02, CAS05, CAS08, CAS11, CAS14, CAS17) must equal 253 (Sequest
ration - reduction in federal payment) when claim filing indicator code (loop 2320, SBR0
9) equals MA or MB and service line paid amount (loop 2430, SVD02) is greater than 0.49.
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We posted all of the primary Medicare payments via ERA through RM. So, not sure if the IG is not set correctly since there are technically 2 different adjustment amounts from Medicare (contractual adjustments and sequestration adjustments).
Is this something can be fixed?
Thanks,
Steve
Medical Billing Professionals
- Gavin Walker
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Re: Secondary Claim Denials
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386
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Re: Secondary Claim Denials
SV1*HC:97140:GP:59:::MANUAL THERAPY TECHNIQUES EG, MOBILIZAT*40*UN*1***1
DTP*472*D8*20171017
REF*6R*254306
SVD*12202*19.58*HC:97140:GP:59**1
CAS*CO*253*.4**59*8.69**45*5.64**237*0.69
CAS*PR*2*5
DTP*573*D8*20171101
AMT*EAF*5
Medical Billing Professionals
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Re: Secondary Claim Denials
BUT per Availity there is a payer specific edit and they consider the legislative adjustment to be sequestration (which it is) and they want to see 253, not 237.
So I guess I just have to send secondary claims to this payer on paper, right? Or can anything be done to create an IGuide just for this payer so if it says CO-237 it changes to CO-253?
Steve
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Re: Secondary Claim Denials
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Re: Secondary Claim Denials
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Re: Secondary Claim Denials
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Re: Secondary Claim Denials
Medical Billing Professionals