DESCRIPTION OF THE ISSUE
We haven’t filed
claims with N and NU ESPDT codes for physical examination procedures.
Hence we received denial stating “Invalid/need referral check codes”
CONCEPT
For Physical examination
codes (99381-99395) we must enter Child Check up code “N” and its valid
referral code “NU” in EPSDT fields for Medicaid insurance.
SOLUTION
Based on the denials
received from Medicaid, we scrutinized the reason for the given denials and
found per Medicaid rules to file Physical Examination codes along with N and NU
ESPDT codes to have the claims reimbursed. Hence the claims were refiled
with the same and got reimbursement on the same. Henceforth the rule was
set towards the Charge entry executives file these procedures with ESPDT codes
for Medicaid without fail.
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