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  • Posting Date: 07/17/2025
    Prior Authorization Outpatient Department Claim Billing

    Prior Authorization Outpatient Department Claim Billing Providers may observe an increase in claim denials for PA services due to a mismatch of information provided on the PAR compared to the information supplied on the claim. Prior [...]

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  • Posting Date: 10/26/2022
    Prior Authorization OPD Alerts

    Prior Authorization OPD Alerts Month/Year Topic July 2025 Prior Authorization Outpatient Department Claim Billing July 2025 Prior Authorization Outpatient Department Exemption and ABN ADRs [...]

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  • Posting Date: 07/18/2025
    52MUE

    Avoiding/Correcting This Error You have the right to submit an appeal when you believe the medical records support that the denied services were reasonable and medically necessary. Providers should review the information on the CMS website [...]

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  • Posting Date: 07/18/2025
    32243

    Avoiding/Correcting This Error Review the claim and either update the charges or remove the line containing zero or blank charges. Return the claim for processing. 

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  • Posting Date: 07/18/2025
    34538

    Avoiding/Correcting This Error To avoid this error: When submitting your Medicare primary claim, report the reason Medicare is primary using claim coding in Prevent an MSP Rejection on a Medicare Primary Claim. To correct this [...]

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  • Posting Date: 07/18/2025
    32402

    Avoiding/Correcting This Error Verify HCPCS code using the FISS Inquiries HCPCS file (option 14). Allowable revenue codes will be displayed based on DOS. Use the claims correction option to report the appropriate HCPCS/CPT code and resubmit [...]

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  • Posting Date: 07/18/2025
    38032

    Avoiding/Correcting This Error If duplicate claim was submitted in error, no additional provider action is necessary. If it is determined that the claim was due to additional charges for a patient for a specific date of service, wait for the [...]

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  • Posting Date: 07/18/2025
    38312

    Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim.   To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]

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  • Posting Date: 07/18/2025
    39929

    Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

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  • Posting Date: 07/18/2025
    39934

    Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

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