One of our E&M claim denied by insurance company as duplicate claim. When we followed up with the carrier we got an information that another provider had billed this very same claim. and Rep adviced that we can resubmit the claim with an appropriate modifier so that it can get re-processed.
Is there any particular modifier for this case. I checked Modifier 76 but we can't append this modifier with E&M Service. I need an advise to solve this issue
Do you know what the other providers speciality is, or what the diagnosis was that he was treating and reported on his claim?
What is your providers speciality and what is the diagnosis that he treated and reported on his claim?
If another provider also reported subsequent visits for the same diagnosis as your provider the insurance MAY be denying because of that, especially if the other provider is of the same speciality. There is no reason why two different providers need to follow and treat a patient for the same reason/diagnosis.