Frequently Asked Questions - Claims Processing
All FAQs are current as of the date noted next to the question.
- What does my denial message mean? (06/20/06)
- What do I do if I have a claim that denies for other health insurance information? (06/20/06)
- Why would a claim deny as routine? (06/20/06)
- Who can a provider contact for more information regarding the Electronic Remittance Advice (ERA)? (06/26/06)
- Why did my claim deny for bundling? (09/25/06)
- Why did my Co-Surgery claim deny? Does Medicare pay for co-surgeons? (06/04/07)
- When should I call for status regarding a remittance notice? (06/04/07)
- We utilize a billing service to file our Medicare claims. Frequently, you deny the claims we submit as duplicate services. What is going on? (08/20/07)
| 1. | What does my denial message mean? | ||||||||||||
The Medicare Summary Notices (MSN) are useful tools in order to determine why your claim denied. You can find definitions to denial messages at: http://www.wpc-edi.com/codes Rev. (06/20/06) |
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| 2. | What do I do if I have a claim that denies for other health insurance information? | ||||||||||||
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A patient's eligibility is available through the Interactive Voice Response (IVR) System. After entering the required information, the IVR will provide Medicare Secondary Payer (MSP) Information and HMO information. If the IVR does not specify any other coverage, Medicare is the primary policy.
Medicare requires payment information from primary policies before processing a claim. If you believe the coverage information on file is incorrect, please contact the beneficiary to have them update their record.
Rev. (06/20/06) |
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| 3. | Why would a claim deny as routine? | ||||||||||||
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WPS Medicare denies claims as routine if a claim does not demonstrate medical necessity.
Rev. (06/20/06) |
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| 4. | Who can a provider contact for more information regarding the Electronic Remittance Advice (ERA)? | ||||||||||||
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You may utilize the following numbers for questions regarding ERA's or any other electronic billing issue: Wisconsin, Illinois, and Michigan: 877 567-7261 Minnesota: 952 885-2811 952 885-2881 952 885-2882 Posted (06/26/06) |
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| 5. | Why did my claim deny for bundling? | ||||||||||||
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CMS has developed the Correct Coding Initiative (CCI) to ensure that the most comprehensive groups of codes are billed rather than individual component parts. For more information regarding the CCI please visit CMS' Website at: http://www.cms.hhs.gov/NationalCorrectCodInitEd/  Posted 09/25/06 |
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| 6. | Why did my Co-Surgery claim deny? Does Medicare pay for co-surgeons? | ||||||||||||
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The data found in the Medicare Physicians Fee Schedule Database (MPFSDB) addresses billing guidelines such as co-surgery. Additional documentation is needed for Medicare to make a payment determination, when the procedure code has a modifier 62 and a co-surgeon indicator of "1" on the MPFSDB. For more information, please see the article (Are You Billing Co-Surgery Claims and Getting Them Denied the First Time) in the May 2007 Communiqué. Posted 06/04/07 |
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| 7. | When should I call for status regarding a remittance notice? | ||||||||||||
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Providers receiving electronic Remittance Notices should be aware that our Customer Service Representatives are unable to access claim information for one business day following the date of the notice. Should you need to contact Medicare, please delay your calls by one business day in order to receive the most accurate information. Posted 06/04/07 |
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| 8. | We utilize a billing service to file our Medicare claims. Frequently, you deny the claims we submit as duplicate services. What is going on? | ||||||||||||
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Duplicate denials are a major concern for Medicare. By category, these types of denials are frequently avoidable. Be certain that your billing service understands the appropriate length of time Medicare must take to process an original claim. The times frames for Medicare processing are 14 days for a claim filed electronically, and 28 days for claims filed on paper. If your billing service re-files a claim in less time than Medicare takes to process the original, the second claim will deny as a duplicate against the claim already in process. Posted 08/20/07 |
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Page Last Updated: Wednesday, 26-Mar-2008 10:25:29 CDT
