97 -Payment is included in the allowance for another service/procedure.
Check whether the modifier is append for particular line item or take the w.o.
22 -Payment adjusted because this care may be covered by another payer per coordination of benefits.
We have to find the correct payer by verifying and resubmit the claims
CR 84 – Please submit history and physical,er report, progress notes, and discharge summary for review of this claim
We will send the Medical records along with claim for reprocess
204 – This service/equipment/drug is not covered under the patients current benefit plan
We will bill patient as service not covered under patient plan
197 -Payment adjusted for absence of Precertification /authorization
Check authorization in hospital website if available or call hospital for authorization details. If it is for office visit clarify with insurance by calling.
133 -The disposition of this claim/service is pending further review.
Claim denied for medical records and the same was submitted to insurance
51- These are non-covered services because this is a pre-existing condition
If the additional information available than we bill the claims along with medical records. Else we bill the patient.
56 -Medicare EOB is required to process this claim
Send the claim along with medicare eob to reprocess the claim
29 -The time limit for filing has expired.
Need to appeal the claim with proof of timely filing particularly clearing house proof.
MA122 -Missing/incomplete/invalid initial date actual treatment occurred.
Submit the claim along with first treatment date to reprocess the claim.