Wiki ASC billing claim form

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gmcintosh

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Our office has just received a denial from United Health Care, that states we are billing on the wrong claim form (HCFA 1500) for ASC services. They are isisting that we should have billed on a UB04 since the servic took place in our office. We are contracted and certified as an ASC facility and have not had problems in the past using the HCFA 1500 so long as we have attached the -SG and the billing provider is listed as the facility. Has anyone else had this issue or am I wrong and should we be billing on a UB04?
Thanks in advance for any help with this matter!
 
Need a bit more information.

Is the insurance a Medicare Replacement Plan / CMO?

Have you reached out to their claim processing and referenced which policy was utilized in the claim denial?
 
sg modifier

gmcintosh said:
Our office has just received a denial from United Health Care, that states we are billing on the wrong claim form (HCFA 1500) for ASC services. They are isisting that we should have billed on a UB04 since the servic took place in our office. We are contracted and certified as an ASC facility and have not had problems in the past using the HCFA 1500 so long as we have attached the -SG and the billing provider is listed as the facility. Has anyone else had this issue or am I wrong and should we be billing on a UB04?
Thanks in advance for any help with this matter!
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I am new and have read that we no lomger use SG modifier for facility claim except to medicaid..... Please clarify
 
Hello,

You should be billing on a UB-04 unless otherwise stated by your contract with the carrier or the carrier's billing guidelines. I bill ASC fees to UHC on a UB-04.

Modifier -SG is not needed. The only payer that I am aware of that requires modifier -SG is Department of Labor.
 
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