DESCRIPTION OF THE ISSUE
While filing V61.20 Dx
codes either as primary, secondary or tertiary claims were denied for “Invalid
Dx under provider’s contract”. We are not suppose to file Dx
V61.20. for this provider towards MCD and its HMOs
CONCEPT
Provider should renew
his contract to get reimbursed for the claims filed with Dx V61.20 since the
provider is not in contract to perform the same.
SOLUTION
On receiving denials from the carrier we
started omitting DX V61.20 and refiled the claims with the other available DX
codes. This enabled reimbursement of claims. Hence forth we Charge
entry executives were instructed to avoid filing Dx V61.20. for Medicaid and
its HMO claims.
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