Facilities
Hills and dale hospital is located in which State?
Hills & Dales General Hospital was founded in 1985 and is located in Cass City, MA
This denial occurs when the diagnosis code does not justify the procedure performed.
Not Medically Necessary
What is the most common cause of a “No Authorization” denial?
failure to obtain pre-authorization before rendering the service
What does a “COB Denial” usually indicate?
payer confusion or missing information about primary vs. secondary coverage
A denial reading “Required modifier missing” often happens due to what?
Billing a CPT that requires modifier 25, 59, or X modifiers without adding it
Allendale County hospital is located in which State?
What kind of Allendale county hospital is ?
Address: 1787 ALLENDALE FAIRFAX HWY, FAIRFAX, South Carolina- 29827
Acute Care, Critical Access Hospital
A denial stating “DX inconsistent with CPT” generally indicates what kind of error?
coding mismatch between diagnosis and procedure code
How can a biller avoid recurring “Authorization expired” denials?
verifying auth validity and date range before billing
What form or data should be verified to correct COB-related denials?
Patient’s insurance coordination on file or the EOB from the primary payer
What is the purpose of modifier 25?
Indicate a significant, separately identifiable E/M service on the same day as a procedure
Marlette Regional Hospital hospital is located in which State?
Michigan
What should a biller check first when a claim is denied for “non-covered services”?
payer’s medical policy and LCD/NCD guidelines
Which document confirms that the payer has approved the service in advance?
pre-authorization letter
A claim denied as “Patient covered under another plan” should prompt the biller to do what?
update the insurance order and resubmit to the correct primary payer
A payer requests medical records before processing a claim. What kind of denial is this?
Additional Information Needed
Meeker Memorial hospital is located in which state?
Minnesota
Which modifier helps indicate that a procedure was distinct and separately identifiable?
modifier 59
A denial indicating “patient enrolled in hospice” typically applies to which payer type?
Medicare Part A
What’s the best prevention strategy for COB denials?
verifying active insurance and payer order at registration
For outpatient therapy services, which modifier indicates plan of care certification?
modifier KX
Hills and Dale Tax Id?
Allendale Tax id?
Marlette Tax id?
Meeker Tax id?
Hills and Dale-381619577
Allendale- 576001334
Marlette-381507302
Meeker-611804389
When a denial mentions “experimental or investigational service,” which category does it fall under?
Medical Necessity Denial
When a patient is in hospice, claims for non-terminal conditions must include what modifier?
modifier GW
If the patient’s coverage lapsed before the service date, the denial reason is likely due to what?
Inactive eligibility or termination of coverage
What is the best practice when a claim is denied for “documentation not received”?
Submit required clinical notes promptly and track reprocessing