Identifying Claim Adjustment Reason Codes: Matching Situations |

Ch. 13 Worksheet Identifying Claim Adjustment Reason Codes and Remark Codes In the first part of this assignment you will be matching adjustment reason codes with the following situations.See pages 413-415 in your book for Claim Adjustment Reason Codes 1. $25 deductible: 1 2. Billed a colonoscopy and biopsy without the 59 modifier (failed to follow CCI edits): 4 3. You found out after billing the patient for 6 months that they had BCBS insurance.BCBS only allows 4 months to submit claims.: 29 4. Patient's insurance ended 3/31 and we billed $600 for services 4/2: 27 5. A physician interpreted an EKG at 12:02AM 4/30.Patient died at 11:59 PM 4/29: 13 6. Billed Medica $100.Patient has met their deductible and has an 80/20 plan.How would they deny the $20: 37 7. Keyed a diagnosis of abnormal menstruation on a male physical in error: 7 8. Coordination of benefits issue: 22 9. We obtained a prior authorization for surgery but didn't include it on the claim: 15 10. BCBS denied indicating auto should be paying the claim: 62 Using the same link as above, indicate what should be done for each of the following situations: appeal the claim, write it off, bill the patient, or resubmit the claim.Remember that when a claim is rejected, the provider may correct and resubmit the claim, but it cannot be appealed.When a claim is denied, the provider cannot resubmit the claim but can appeal the decision. 1. A claim paid zero dollars by the insurance company.Reason code is PR-01.What should be done? Bill patient 2. A claim was rejected.Reason code is CO-04.What should be done? Fix the claim and resubmit after correcting modifier issue. 3. A claim was denied.Reason code is CO-29.What should be done? Appeal because the filing time was expired