Neurology & Pain Management Coding Alert

Question: When we know that the carrier has made a mistake in denying a claim, can we simply resend the original claim again, or will the carrier automatically deny it again?

North Dakota Subscriber Answer: Although simply resending a claim that the carrier erroneously denied sounds like a logical, easy answer, in the end it might cost you more time and effort. The carrier denied the claim for a particular reason during the first round of submission. If you don't learn the reason -- and address it -- your claim will likely return to you as a denial again.

Possibilities: Many things can go wrong that will result in an erroneous denial. Problems with patient pre-authorization, physician credentials with the carrier, an oversight on your part on the claim, or problems with the carrier's processing systems (or other problems) could all cause an incorrect denial.

Good practice: Rather than automatically resending the claim, contact your carrier representative. Discuss the denial with the representative, and figure out why the carrier denied the claim. A short phone call could save you much more time in the long run.