Hi all, Here I am new to denial management and I need your support on below scenario.
As per my documentation there provider A had rendered 99233 service on 030615 & 030715 with the dx sequence 434.91,250.00,585.9 & 780.09 and for the same date of services provider B also rendered 99233 service with the dx sequence 431,780.09 & 348.5.
I went through the specialty of the above mentioned providers, both are different specialties
In this case the provider B charges got denied as a duplicate and I tried with an appeal again it got denied as non-covered charges.
Please I need your suggestion on above mentioned scenario,
You can't have both specialities seeing patient for the same thing. Services provided should match up to the speciality. Ex: Cardiologist See patients for heart. Neurosurgery sees patient for SDH. Another thing to consider, are you billing under the same tax id for both specialities? If so, is the tax id considered a multi-speciality group or does that payer have you listed as a multi-speciality group? The best bet is to call the insurance carrier and ask the exact nature of the denial.