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ASCs in the news: Texas ASC top denial, reject reasons for first quarter 2008 announced
Ambulatory Surgery Reimbursement Update, May 13, 2008
Trailblazer Health Enterprises, a major Medicare contractor headquartered in Dallas, has announced the top 10 denial and rejection reasons for Texas ASCs during the first quarter of 2008.
The reasons were:
- Duplicate claim/service
- Missing/incomplete/invalid group practice information
- Treatment rendered in an inappropriate/invalid place of service
- Procedure inconsistent with provider type/specialty not covered when performed by this provider
- Claim not covered by this payer/contractor
- Medical necessity
- Service not covered unless provider files an electronic media claim
- Procedure inconsistent with modifier used or required modifier missing
- Service covered by another payer per coordination of benefits (working- aged beneficiary)
- Beneficiary eligibility
According to its Web site, TrailBlazer is one of the largest Medicare contractors in the nation. It has operations in eight states and the District of Columbia, and is fiscal intermediary or carrier for several national and regional programs. To read the complete report (including detailed descriptions and resolutions), click here.
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