Wiki Molina Medicaid and Observation

[schanderson]

I am curious to find out if anyone else is having this issue. I have tried to bill for this patient for observation from Molina Medicaid and they keep stating that I need a modifier. I have tried the only one that I know of UD thinking that was possibly it and they still say that it needs a modifier. Literally the billed observation for the same patient in September and was paid. However, the November one keeps getting denied. I am looking for suggestions since Molina cannot tell me what I modifier needs to be attached to the observation claim.

 

[kzeug]

25? GC?

Kelsey, CPB

 

[EPIPHANIECANCODE]

Molina Medicaid and OBSV

from my experience, Mod 25 is usually attached to the ER portion on observation claims. I have seen observation claims come back for modifier issues when the number of OBSV hrs billed exceed 48 and Modifier GZ is attached to it; per TMHP guidelines, this is not allowed.