Forum - Questions & Answers
Using modifiers correctly
Hi
I recently submitted a DME claim (oral appliance) to Empire BCBS for payment. They denied saying that "maximum units are fulfilled", but if I were to attached the correct modifier to the claim it will be considered for payment. I have checked high and low for this modifier.
Do you have any idea which one to use?
re: USING MODIFIERS CORRECTLY
Reason Code 151 and Remark Code N362
If this is not reason code, what is your reason and remark code?
re: USING MODIFIERS CORRECTLY
This denial may indicate that the number of items provided exceeds the usual acceptable maximum. It may also be an indication that another supplier has billed for the same or similar item(s) with overlapping or conflicting dates.
These denials typically must be appealed through redeterminations. Be sure to include documentation that supports the number of units you have dispensed.