Insurance Claim Denials and Coverage Verification
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Questions and Answers

What action should be taken if BCBS denies a claim for CPT code 76514 with modifiers RT/LT indicated?

  • Contact BCBS to confirm if the service is covered under the patient's plan
  • Submit the claim with different modifiers for reconsideration
  • Submit the claim without any modifiers added (correct)
  • Bill the patient directly for the service

    • What action should be taken if CPT code 92250 is denied with the reason 'mutually exclusive procedure/s cannot be done on the same day/setting' when billed with CPT codes 92134 or 92133?

  • Appeal the claim with medical records if modifier 59 is already present on CPT code 92250 (correct)
  • Write off the claim as a disallowance and note the account details
  • Add modifier 59 to CPT code 92250 and submit a corrected claim
  • Inform the co-lead or lead if the appeal is denied or denial is upheld

    • When CPT code 92250 is billed with CPT codes 92134 or 92133, what should be done to prevent a denial?

  • Appeal the denial with the insurance company
  • Append modifier 59 to CPT code 92250 and send a corrected claim (correct)
  • Remove CPT codes 92134 and 92133 from the claim
  • Do nothing, as the denial is expected

    • What should be done if CPT code 92250 is billed with modifiers 52LT or 52RT and a denial for 'required modifier is missing' is received?

    <p>Confirm with the office if the service was stopped or reduced, and appeal the claim if appropriate</p> Signup and view all the answers

    If BCBS sends a denial stating 'prior processing information appears incorrect' when a corrected claim is submitted, what does this indicate?

    <p>The claim is being reviewed for adjudication</p> Signup and view all the answers

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