Invalid-Incorrect HCPCS Modifier Newsflash_07172014.doc

Invalid-Incorrect HCPCS Modifier Newsflash_07172014.doc -...

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Provider News Flash July 2014 Invalid and Incorrect HCPCS/Modifier Combinations Purpose of this Communication To educate providers about claim rejections and denials based on invalid or incorrect HCPCS/modifier combinations and how these rejections and denials can be prevented and corrected so that a claim can be accepted for processing by CareCentrix. Invalid HCPCs/Modifier Combinations Claims are rejected by CareCentrix based on an invalid HCPCS/modifier combination (rejection code A3453) when the combination billed does not exist on the CareCentrix billing crosswalk. Example: An authorization is issued for Antibiotic Therapy, S9500 (Q24-Primary). The Service Authorization Form (SAF) indicates the HCPCS/modifier combination of S9500-SQ. The submitted claim is coded with combination S9500-NU. Because S9500-NU does not exist on the CareCentrix billing crosswalk, the submitted claim is rejected back to the provider with code A3453 .
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