#NOT

NOTE: Please CORRECTION HERE:
We can not resubmit (with resubmission code 7 ) a corrected claim to Traditional Medicare (Just we refile after coding corrections). But for HMOs or managed care we can do. Thank you.
#Not medically necessity
#Denial management
#Medical billing
#AR in Healthcare
#Medical coding
#AR
#US HEALTHCARE DOMAIN
Summary: If services are not covered as per LCD & NCD guidelines, then claim will be denied as services are not medically necessity. Denoted by denial code 50. This denial commonly seen in Medicare and Medicare advantage plans. Provider need to check whether services are covered as per LCD, NCD guidelines under the patient. We need to forward claim to coding team in further. After coding correction done have to rebill the corrected claim with resubmission code 7. If no coding correction required, need to check if ABN signed and if ABN signed then BILL PATIENT. If ABN NOT SIGNED, provider need to WRITE OFF THE CLAIM BALANCE thats mean that CLAIM WILL BE ADJUSTED.
ABN: Advance Beneficiary Notice (ABN) for non covered services as per Medicare guidelines, also known as a waiver of liability.
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[@manikyaraogogumalla8903]

Super sir , i got great information

[@PKRVibesCareerGrowth]

Thank you.

[@parthasarathyvenkatachari2617]

@@PKRVibesCareerGrowth sir one doubt if we have PR50 denial only then we can chk ABN right? but since we have co-50 and coding is correct means then what need to do

[@PKRVibesCareerGrowth]

@@parthasarathyvenkatachari2617 yes you have to check ✔️ ABN if services not covered scenarios. On denials CO 50 if coding team commented as already coded correctly, no further correction required. Then please go for Appeal on claim with complete medical records to prove the medical necessity 👍😊

[@Sachin_Nair14]

Thank you sir

[@PKRVibesCareerGrowth]

@@Sachin_Nair14 Welcome you 🤝

[@Potatoesarelife234]

Thank you

[@PKRVibesCareerGrowth]

Welcome you 🤗

[@sateeswarareddy9939]

If you know about epic software, please share how to use it. when claims are denied , what to do, what & how to take action. And provide denial codes

[@PKRVibesCareerGrowth]

Ping me at [e-mail]

[@chmukeshkumar5260]

Open the eob there you find remittance code and denial reason based on that you should take action

[@Tahseenshaikh-if5mn]

If u have mentioned about lcd ncd guidelines u should teach us how to check on ncci edit tools

[@PKRVibesCareerGrowth]

Sure

[@Tahseenshaikh-if5mn]

How to check abn signed or not by patient

[@AkaashTanti]

Any provider will send notice to patient to sign ABN

[@pyarababu5194]

Can we send corrected claim to medicare in medical necessity denial.. ( i was aware that we can never send corrected claim to medicare) .. Please correct me

[@PKRVibesCareerGrowth]

Yes your thought is right. Irrespective of any denial or scenario, Traditional MEDICARE will never accept any corrected claims with resubmission code 7.

[@PKRVibesCareerGrowth]

Your correct. Yes mentioned but you can correct to HMOs or managed care plans only. But for Medicare we can't do.

[@pyarababu5194]

@@PKRVibesCareerGrowth sir i confirm with my senior they said we can only refile claim to insurance if correction done by coding.

[@PKRVibesCareerGrowth]

@@pyarababu5194 yes only we refile but not as corrected claims. Your assumption is right. 👍

[@pyarababu5194]

@@PKRVibesCareerGrowth thanks sir

[@vadlashivakumar7657]

If coding correct... No chance of reprocess?

[@PKRVibesCareerGrowth]

You can call payer, probe the same and reprocess .

[@TheIntrovertcore]

What about commercial payers? How to check for them?

[@PKRVibesCareerGrowth]

Mostly commercial payers not denied for this scenario. If they denied need to call payer for clarification

[@mukeshgupta404]

Do you have any notes or video for Epic Software?

[@PKRVibesCareerGrowth]

Hi Mukesh. I didn't have any video about any particular software yet.

[@Manupresents-939]

How do we work for traditional medicare

[@PKRVibesCareerGrowth]

Same work flow like other Payers. Please note that we have work on Denials. Mostly denial work flow/ Denial management will not different from Payer to Payer.

[@karthikeyane9475]

Bro can tell c040

[@PKRVibesCareerGrowth]

1st check,if claim denied for emergencies room services, 1st check claim form is billed with pos 23 or not. If not bill with pos 23. If already billed with pos 23, call n probe the same on phone call and sent claim back for reprocessing. Note: if pt plan doesn't have ER benefits. Call n confirm the same and do bill pt.