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Orthopedic Coding Alert

Reader Questions:

File Electronically and by Paper When Necessary

Published on Tue Jun 27, 2006

Question: We have difficulty filing paper claims for unlisted-procedure codes. Our payer says we are not in compliance with -timely filing- requirements. Do you have any suggestions?

Massachusetts Subscriber Answer: Many payers require electronic claims as proof of timely filing. But on many occasions, you must provide full documentation and therefore you should file a paper claim -- such as when you file claims with unlisted-procedure codes, or claims with modifier 22 (Unusual procedural services) or reduced or discontinued services (modifier 52 or 53).
 
The solution is simple: File the claim electronically and then submit paper documentation separately. Be sure to include a note with the paper claim explaining, -This is not a duplicate claim. This documentation supports an electronic claim.-
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