I work for a orthopaedic physician practice that has multiple therapy location. We have been receiving denials from Medicaid for all of crossover claims. The denial reasons vary, but the most frequent ones are - 4802 (no contract for billed diagnosis and 4801 (services cannot be billed on this claim form or provider type listed for this provider number cannot file this type of claim). Our physical therapists are credentialed under COS (category of service) 410 and our occupational therapists are credentialed under COS 420. We rarely get rarely get paid by Medicaid. I have searched the GAMMIS portal and can't find a manual for therapy claims processing and no Medicaid representative can provide me with any help either. Essentially, I want to know can we get reimbursed by Medicaid and if we can, how do we go about it? If any one can provide any insight on where to go to find the answer I would greatly appreciate it.
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Wiki Outpatient Therapy and Medicaid
- Thread starter cmcnear
- Start date
dedje45
New
Hi there,
I currently do the coding for a mental health agency that works almost exclusively with medicaid, both state and local. Medicaid is notoriously picky about authorizations being in place prior to services being provided, though I've never been 100% clear on how to accomplish this when a patient has open card/OHP coverage. When we DO have an authorization for service in place, sometimes our claims get denied because the provider is registered with the local CCO, or there was some error in the registration process--either on our end or theirs. It's a headache and never straight forward.
Can you recall if it's all medicaid CCOs or just a few that deny your claims? I would check first for their prior authorization requirements and submission process, and then look into any particular provider registration the individual CCO might expect.
I hope this is in any way helpful and that your denials get sorted out soon!!
I currently do the coding for a mental health agency that works almost exclusively with medicaid, both state and local. Medicaid is notoriously picky about authorizations being in place prior to services being provided, though I've never been 100% clear on how to accomplish this when a patient has open card/OHP coverage. When we DO have an authorization for service in place, sometimes our claims get denied because the provider is registered with the local CCO, or there was some error in the registration process--either on our end or theirs. It's a headache and never straight forward.
Can you recall if it's all medicaid CCOs or just a few that deny your claims? I would check first for their prior authorization requirements and submission process, and then look into any particular provider registration the individual CCO might expect.
I hope this is in any way helpful and that your denials get sorted out soon!!