August 2024 Issue
Avoid Claims Denials or Delays With These Tips
Unnecessary claim denials or delays can cost you valuable time. In many cases, these issues can be avoided by ensuring your claims include all required information – and that the information is correct.
Here are tips to help you avoid some of the most frequent issues on Medicaid claims:
- Common Error #1 – Missing required modifier. Claims should be submitted with all applicable and required modifiers, as outlined in the Wisconsin Medicaid Community Plan Care Provider Manual.
- Denial details: If a Medicaid claim is submitted without the required modifiers, the claim will deny as “Service is not contracted.”
- What to do differently: Review the Step-by-Step Instructions for Looking Up Modifiers before you submit claims to ensure you are included all required information.
- Common Error #2 – Incorrect billing NPI/taxonomy. The information submitted must match the current ForwardHealth (Wisconsin Medicaid) provider enrollment information on file: The taxonomy you used to register as a Medicaid provider; your National Provider Identifier (NPI) number; and the address associated with your taxonomy and NPI number. This applies to both the billing and rendering providers submitted on claims.
- Denial details: Invalid/incorrect rendering or billing provider. Provider not eligible per state.
- What to do differently: Review categories of Medicaid provider enrollment and the demographic changes that require notification to Forward Health. As needed, submit those changes before you submit the claim.
- Common Error #3 – Incorrect telehealth billing. Claims for telehealth services must include the appropriate procedure code, place of service (POS) code and any required modifiers. All services provided via telehealth must be thoroughly documented in the member’s medical record.
- Denial details: A12 Not Contracted.
- What to do differently: Review the ForwardHealth billing guidelines and telehealth resources for more information on accurate claim submissions, policies, frequently asked questions handbooks and more.
How to correct claims
For these or any other errors that cause a claim to be denied or paid incorrectly, you can update the claim. Simply check the initial claim submission, add or update the required information, and submit a corrected claim.
Questions? You can contact your Wisconsin-specific Network Management representatives or call the Provider Service Line at 1-877-614-0484.