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andersont

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Has anyone had difficulty with claims getting rejected that are being billed to United Healthcare? It's funny because it's not with every claim. I get this rejection.....

P4999INFO SmartEdit (INFO) [Pattern 28487] For additional information regarding this edit, refer to our Smart Edits Guide at UHCprovider.com/SmartEdits.
Missing or invalid information. Note: At least one other status code is required to identify the missing or invalid information.

I had to go out to Twitter to have someone call me back that I could understand. This is what I billed

99213-25
11102
11103 2 units
17000-59
17003-59 2 units

This was rejected for the reason above. I spoke with the UHC gal and she said I needed 59 on the bx codes also. SO, I did what she said. Rejected again. I have had some where I was told to remove the 25 modifier, so I did and then it got denied because there wasn't a modifier.

Help.
 
Was there an additional status code to explain what the missing/invalid information is? If not, I would call UHC back to ask them what they are showing the missing/invalid info is. I see no issue with the modifiers as shown, assuming that the biopsy and destruction were for separate lesions and the e/m was separately supported.
 
iowagirl77 said:
Was there an additional status code to explain what the missing/invalid information is? If not, I would call UHC back to ask them what they are showing the missing/invalid info is. I see no issue with the modifiers as shown, assuming that the biopsy and destruction were for separate lesions and the e/m was separately supported.
Click to expand...
I did call UHC and I was told I would need to talk to the coder in our office. I said “I am the coder”! These off shore people know nothing. I left a message for the media customer service gal I got from Twitter. We will see what she says
 
Most of my SmartEdit rejections are not actual rejections. The claims go through to the carrier. I check that before I do anything else. UHC also has a Smart Edit Guide at

Modifiers seems to trigger this response more than anything else. Definitely double check to see if the claim is entered into the UHC system a couple days after the Smart Edit message is received. Chances are that the claim is received, but may be delayed.
 
andersont said:
Has anyone had difficulty with claims getting rejected that are being billed to United Healthcare? It's funny because it's not with every claim. I get this rejection.....

P4999INFO SmartEdit (INFO) [Pattern 28487] For additional information regarding this edit, refer to our Smart Edits Guide at UHCprovider.com/SmartEdits.
Missing or invalid information. Note: At least one other status code is required to identify the missing or invalid information.

I had to go out to Twitter to have someone call me back that I could understand. This is what I billed

99213-25
11102
11103 2 units
17000-59
17003-59 2 units

This was rejected for the reason above. I spoke with the UHC gal and she said I needed 59 on the bx codes also. SO, I did what she said. Rejected again. I have had some where I was told to remove the 25 modifier, so I did and then it got denied because there wasn't a modifier.

Help.
Click to expand...
Many of the commercial payers, specifically UHC and the Blue's are denying claims with 25 modifiers and 59 modifiers. They are doing so to "test" your documentation. The various medical associations are all over this situation as it is not the payer's job to test. You will need to appeal with a copy of your encounter notes once you get an actual denial. In the meantime, push past the smart edits to get the claim to process.
 
Here is my question how many lesions for the 17000 and 17003 where done.
17003 is for the 2-14 lesions you are billing this twice. Were there over 15 lesions? There would have to be 16 or more to bill the 17003x2

You can only bill the E/M with 25 if there is another dx or reason for visit. If visit is just for lesions than can't bill the E/M
Would consider using XS for separate lesion instead of 59 on 17000 if payer allows X mods:)
59 or XS isn't required on the 17003 just the 17000:)
 
You should be able to push those claims back through. I get smart edit rejections ALL THE TIME. They are BS and don't really mean anything. If you submit the claim again as is it will go through to the payer.
 
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