With the new year has come several new reasons for denials of some of our insurance claims. There were many CPT code changes that went into effect on January 1 so some of the denials we see are a result of these code changes. Others, not so much.
One of the ones I found most interesting was for the first 12 claims I filed with a managed Medicaid carrier of the new year. The denial stated that the provider was not qualified to submit these codes. I figured the problem was it the new codes, but a telephone call to the carrier revealed that the provider was not updated in the computer which they quickly corrected and reprocessed the claims.
Of course, you will find one or two carriers who were not yet ready for the new codes. It seems the workers comp carriers seem to be behind in this area. The point is to look into each denial reason and find out what the real problem is and then deal effectively with it.