![]() Note: If the modifier is inconsistent with procedure code or modifier missing. Faxing is the preferred method for providers to submit Level I appeals to Blue Cross NC.Let us see some of the important denial codes in medical billing with solutions: Denial Codesĭenial Codes / Remit Codes Description in Medical Billingĭenial Codes in Medical Billing / Remit Codes -Solutions or Questions need to ask with Insurance representative.Ģ) Get the allowed amount and the amount that was applied towards the patient's deductible?ģ) Get the payment details if there was any?Ĥ) Get the patient's calendar year/lifetime deductible and how much of it has been met? (Note: If annual deductible is already met, reprocess the claim)ĥ) Get if the claim is processed towards in network or out of network deductible and how much deductible?Ħ) Get the Claim number and Calreference number?Ĭoinsurance: Percentage or amount defined in the insurance plan for which the patient is responsible.Ģ) Get the allowed amount, paid details if any and the amount that was applied towards the patient's Coinsurance?ģ) Get the Claim number and Calreference number?Ģ) Get the allowed amount, paid details if any and the amount that was applied towards the patient's Copayment?ĭescription for Denial code - 4 is as follows "The px code is inconsistent with the modifier used or a required modifier is missing".Ģ) Verify whether modifier is inconsistent with procedure code or modifier missing?ģ) Send for reprocess and collect the follow up date, if the denial is incorrectĤ) Get the appeals information/ corrected claims address/ TFL to submit corrected claimĥ) Get the Claim number and Calreference number ![]() Attaching supporting medical information will expedite the handling of the provider appeal.īlue Cross and Blue Shield of North Carolinaįor more efficient delivery of the request, this information may also be faxed to the Appeals Department using the appropriate fax number below. With the form, the provider may attach supporting medical information and mail to the following address within the required time frame. Level I Provider Appeals for billing/coding disputes and medical necessity determinations should be submitted by sending a written request for appeal using the Level I Provider Appeal Form which is available online. The Level I Provider Appeal Process for Medical Necessity applies to adjudicated claims related to:
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