Frequently Asked Questions - Top 10 Phone Inquiries
WPS Medicare publishes Frequently Asked Questions (FAQs) based upon topics we identify as generating a high volume of telephone inquiries to Customer Service. The following table lists the top ten reasons (by topic) our Medicare providers and their agents telephoned our call centers during the months of October, November, and December 2009.
Top 10 Reason Codes for Wisconsin, Illinois, Michigan, and Minnesota:
October, November and December 2009
(Excluding Claim Status and Eligibility Issues)
| Description | Occurrences |
| Contractual Obligation Not Met | 5651 |
| Coding Errors/Modifiers Claim Denials | 5380 |
| Issue Not Identified/Incomplete Information Provided | 5185 |
| Duplicate Claim Denials | 4692 |
| Medicare Secondary Payer (MSP) Claim Denials | 4084 |
| Medical Necessity Claim Denial | 3964 |
| Address/Phone/Fax/Web Address | 2946 |
| Claim Payment Calculation/Explanation | 2849 |
| Appeals Status/Explanation/Calculation | 2067 |
| Frequency/Dollar Amount Limitation | 2055 |
WPS Medicare develops FAQs to specifically address telephone inquiries from the previous quarter's reporting period. We hope the answers to the questions listed below assist you in reducing the need to call our telephone centers and reduce claim errors associated with these topics.
FAQs developed to address Top 10 Inquiry Topics:
1. Topic: Medicare Secondary Claim Denials
Q. My electronic claim denied stating that other insurance was primary over Medicare; however, I included the primary insurance allowed and paid amounts on the claim. Why would it deny?
A. This denial occurs on electronic Medicare Secondary Payer (MSP) claims if the paid amounts and the adjusted amounts by the primary payer do not equal the billed amounts, or if the claim lacks standard claim adjustment reason codes to identify adjustments.
You will find additional information on this topic on the WPS Medicare MSP Page.
2. Topic: Coding Errors/Modifiers
Q. I received a denial of "invalid procedure code/modifier combination" on my claim. I bill an evaluation and management (E/M) service with a 78 modifier. Why would this deny?
A. You should use the 78 modifier with the surgery procedure codes only. It is not appropriate to use on the E/M service.
You will find more information on the correct usage of modifiers on the WPS Medicare Modifier page.
3. Topic: Duplicate Denials
Q. I called the Interactive Voice Response (IVR) system to see if I could find out why I had not received payment on a claim I submitted. The IVR indicated the claim denied as a duplicate. What is going on?
A. Claims deny as duplicate when they "hit" up against another claim that is currently processing or has already finalized. You should wait until you receive your remittance advice before resubmitting the claim for a second time.
You will find more information on duplicate claim denials on our Claims page.
Page Last Updated: Thursday, 18-Mar-2010 05:55:53 CDT
