tag:blogger.com,1999:blog-3296099488484561663.post1262357213649866814..comments2024-02-18T10:32:11.430-08:00Comments on Ask A Medical Biller: Save time by not calling Medicare on denied claimsSLC - Utahhttp://www.blogger.com/profile/05203921533585357343noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-3296099488484561663.post-69620053465288911932012-02-22T15:15:49.410-08:002012-02-22T15:15:49.410-08:00What does Medicare denial CO24 mean? How do I go a...What does Medicare denial CO24 mean? How do I go about getting claims with this code reprocessed and paid?<br /><br />CO24 Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. Note: Changed as of 6/00<br /><br />CO stands for Contractual Obligation<br />If you are billing Medicare and they kick out the claim with a CO it means you need to take that adjustment.<br /><br />Your best bet is to research the CPT codes being billed that result in the CO24 Payment Reason Code.<br /><br />Are they a global service? <br />Are they bundled with another CPT code?<br />Are the inclusive to the main CPT code billed? <br /><br />I would research the CPT code billed.SLC - Utahhttps://www.blogger.com/profile/05203921533585357343noreply@blogger.comtag:blogger.com,1999:blog-3296099488484561663.post-87894864999250600732012-02-22T15:02:12.405-08:002012-02-22T15:02:12.405-08:00This is in response to the CO151 denial -
CO151 ...This is in response to the CO151 denial - <br /><br />CO151 Payment adjusted because the payer deems the information submitted does not support this many services.<br /><br />It's always helpful if you can give more details like insurance carriers, state the services were rendered, CPT codes billed, ICD-9 codes, type of practice etc but here is the nuts and bolts:<br /><br />CO is Conractual Obligation. If you are in network with the insurance carrier you must adjust this portion off and not BALANCE bill the patient. <br /><br />They are telling you that based on the ICD-9 codes billed you do not have enough information to support the # of CPT codes billed. <br /><br />A call to the insurance carrier will probably give you some additional information. Try to be nice to the CS Rep to see if they can guide you to new steps of submitting a corrected claim or rebilling the claim. <br /><br />Mainly you need more information to support the CPT codes. Usually this is through modifiers or ICD-9 codes. Occassionaly it's attaching medical records or additional documentation to the claim.SLC - Utahhttps://www.blogger.com/profile/05203921533585357343noreply@blogger.comtag:blogger.com,1999:blog-3296099488484561663.post-61064685548658189332012-02-22T14:56:20.733-08:002012-02-22T14:56:20.733-08:00PR stands for Patient Responsibility
When you rec...PR stands for Patient Responsibility<br /><br />When you receive a EOB (explanation of benefits) back from the insurance with a PR code it means you can bill the patient for this balance. <br /><br />If you look up PR45 in the above article it is: Charges exceed your contracted/legislated fee arrangement. This change to be effective 6/1/07: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.<br /><br />You may not be in network with the health insurance carrier, the patient may not have been eligible for these services (i.e. they do not have chiropractic or surgery benefits) or it's possible that they do not have benefits for these services (CPT codes are not payable on their insurance plans). It some ways it's a suggestion for adjusting off the balance but when the insurance carrier leads off with a PR code it means that you can bill the Patient for that amount. <br /><br />If you want to give me more details of the situation, insurance carrier, in network / out of network scenarios I could give you more exact answers.<br /><br />45SLC - Utahhttps://www.blogger.com/profile/05203921533585357343noreply@blogger.comtag:blogger.com,1999:blog-3296099488484561663.post-11913556044776285162012-02-22T13:21:20.946-08:002012-02-22T13:21:20.946-08:00How do I appeal a PR45 as a Provider?How do I appeal a PR45 as a Provider?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3296099488484561663.post-33174356756398199562011-12-27T06:36:04.024-08:002011-12-27T06:36:04.024-08:00I am new to this. Can you tell me how to fix a CO...I am new to this. Can you tell me how to fix a CO-151 error. I read what it means but don't know what to do with it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3296099488484561663.post-54610693409072374172011-04-07T08:39:44.647-07:002011-04-07T08:39:44.647-07:00What does Medicare denial CO24 mean? How do I go a...What does Medicare denial CO24 mean? How do I go about getting claims with this code reprocessed and paid?AR GirLnoreply@blogger.comtag:blogger.com,1999:blog-3296099488484561663.post-1652820291728605602008-06-06T20:20:00.000-07:002008-06-06T20:20:00.000-07:00Hi Z,Your question is: what does medicare denial c...Hi Z,<BR/><BR/>Your question is: what does medicare denial code CO38 mean? <BR/><BR/>Answer: <BR/>CO38: Services not provided or authorized by designated (network/primary care) providers. Note: Changed as of 6/03<BR/><BR/>The provider treated a patient without the correct pre-authorization on file or the pre-auth was not approved for the provider who completed the services.<BR/><BR/>I would check to verify you added the pre-auth information to the claim, that it is the correct pre-auth # (number) and confirm the correct provider rendered the medical services to the patient.<BR/><BR/>If you do not find issues with the pre-auth or the medical doctor who rendered services I would place a call with the medical insurance carrier or check online claim status to see if they give you insight to additional denial reasons.<BR/><BR/>Let me know if you need additional assistance with resolving your issue.SLC - Utahhttps://www.blogger.com/profile/05203921533585357343noreply@blogger.comtag:blogger.com,1999:blog-3296099488484561663.post-58144585711159811412008-06-06T14:22:00.000-07:002008-06-06T14:22:00.000-07:00what does medicare denial code CO38 mean?what does medicare denial code CO38 mean?8th Noteshttps://www.blogger.com/profile/09766894465739559650noreply@blogger.com