DESCRIPTION OF THE ISSUE
Per Master claim set up in the software we have
filed all the claims with provider’s group NPI#. But per Medicaid
records, provider was enrolled with Individual NPI#. Hence claims
did not reach Medicaid.
CONCEPT
Before transmission of
any claims, the concerned carrier’s claims acceptance set up should be checked
and verified.
SOLUTION
We had sample cross
over claims which were processed by Medicaid. Based on these sample claims
we placed an enquiry with MCD executives as to why they haven’t received any of
our MCD claims though we receive acceptance reports from our Clearing house
agent. They insisted that the claims should be filed with provider’s
individual NPI. Since the NPI records were missed, they haven’t
received any of our claims.
Based on the given
information we changed our Carrier’s claims submission master up from Group
NPI# to Individual NPI# and transmitted all our claims. The refiled
claims were reached and processed for reimbursements
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