Radiology Coding Alert

Question: Do you have any suggestions for filing paper claims for unlisted-procedure codes? Our payer has said that we are not in compliance with its "timely filing" requirements.

New York 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 filing for unlisted-procedure code claims or modifier 22 (Unusual procedural services), 52 (Reduced services) or 53 (Discontinued procedure) claims.
 
Solution: File the claim electronically and then submit paper documentation separately.
 
Be sure to include a note with the paper claim explaining that "This is not a duplicate claim. This documentation supports an electronic claim."
 
File the paper claim within the payer's allotted timeframe, as well. Don't wait for your electronic claim to be rejected to file the paper claim.
 
If you wait, your payer may say the electronic claim was incomplete and the payer didn't reset the clock for timely filing after receiving the electronic claim.