CREDENTIALING PROCESS FOR NEW PHYSICIANS Overview New physicians/providers must credential themselves, i.e., enroll and attest with the Payer’s network and authorized to provide services to patients who are members of the Payer’s plans. The credentialing process...
Source of Delays in the Credentialing Process: The credentialing process may get further delayed due to few primary causes. They are as follows: Poor response or planning: Many times the response from new physicians or even credentialed physicians for our requests of...
Reimbursement Guidelines Time Span Codes UnitedHealthcare will reimburse a CPT or HCPCS Level II code that specifies a time period for which it should be reported (e.g., weekly, monthly), once during that time period. The time period is based on sourcing from the AMA...
CPT Code Description 93922 Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (e.g. for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler...
Essential (primary) hypertension: I10 In ICD-9, essential hypertension was coded using 401.0 (malignant), 401.1 (benign), or 401.9 (unspecified). ICD-10 uses only a single code for individuals who meet criteria for hypertension and do not have comorbid heart or kidney...
MCR – 835 Denial Code List CO : Contractual Obligations – Denial based on the contract and as per the fee schedule amount. CO should be sent if the adjustment is related to the contracted and/or negotiated rate Provider’s charge either exceeded contracted...
Medicaid Claim Denial Codes 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent with the modifier used or a required modifier is missing. 5 The procedure code/bill type is inconsistent with the place of service. 6 The...
