I need assistance with writing a summary for this question below. I need help wording it to present it to a
Review and research the below scenario and provide your response specifying how the claim should be paid (dollars), and logical steps you took for to arrive at that conclusion. Please provide the resources you used if applicable (i.e. websites, searches, etc.)
· San Francisco Health Plan (SFHP) received a claim from a participating provider in our network
· Claim is from a DME Provider
· Primary insurance is Medi-Cal
· SFHP pays according to the Medi-Cal guidelines
· Claim is billed on a CMS 1500
· An invoice was submitted with the claim for $100.00, with a list price (MSRP) of $120.00
· Claim has the following billed codes
o Claim line #1 E0130 with modifier RR; Claim line #2 E0248.
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