# Caloptima claim



## bench (Jul 29, 2009)

Hi Fellows,

I'm having problem with our CalOptima claim as they are denying the cpt code 19120-LT. I called CalOptima and asked about the problem and what should I do. They said they cannot tell me how to fix this and just go to their webiste. I went to the website and found that the LT modifier is valid so I resubmitted the claim and printed out the page from their website and attached. Now I received another EOB for the same denial reason: 

709 The combination of service code and modifier is not valid.

 This claim is secondary and the primary is Blue Cross. Blue Cross paid with the same code I submitted and now I was wondering what could be the real reason for this denial. We had previous CalOptima claims also and was denied for so many rejections but I tend to fix all those and resubmitted our claims again and again but  keeped on getting denied for other rejection reasons. So, I attended a CalOptima seminar one time regarding this problem and brought all the UB's that I submitted to them and they found no problem, but when they looked on their fee schedule and found that primary payer pays more, they said that if Primary payer pays more than them, they won't pay anymore. Any same experience with CalOptima? Need your advise. Thanks.


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