Quick Tips - Preventing Returned / Denied Claims

Quick Tips - Preventing Returned / Denied Claims

Reduce the time it takes to process your claim and avoid a returned claim by completely and correctly filling in the claim form.

The following items, if missing or incorrect, will delay processing of your claim or even result in a request for re-submission:

  • Subscriber's name
  • Subscriber's member ID number (11-digits)
  • Patient's name and date of birth
  • Date of service
  • UHA group number (4-digits)
  • Name of referring physician for claims from laboratories, radiologists, and consultants
  • Date, place, and cause of injury
  • Descriptive diagnosis and ICD-9 code
  • Descriptive procedures and CPT code
  • Charges
  • Provider's billing name and address
  • Provider or agent's signature
  • Supportive data for modifiers, e.g. after-hours modifier - claim should have time listed
  • Provider Identification Number (PIN)
  • Federal tax ID number

Avoid the following possible claims(s) denials:

  • Claim submitted with Modifier -25 or -57?*
    • Tip: Submit your claims with supporting documentation indicating a significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.
  • Claim submitted with Modifier -59?*
    • Tip: Submit your claim with supporting documentation indicating the service was distinct or independent from other service(s) performed on the same day.
  • Claim submitted with duplicate CPT codes?*
    • Tip: Submit your claim with supporting documentation indicating the service(s) is not a duplicate.
  • UHA is secondary insurance carrier?*
    • Tip: Submit your claim with primary insurance carrier's EOB (Explanation of Benefits)/RA (Remittance Advice).

*You may also apply this information for previously denied claims resubmitted for reimbursement reconsideration

Important note: UHA will not accept ICD-10 diagnosis codes until October 1, 2015. However, UHA has begun accepting the new CMS-1500 claim form. The last day to submit the old CMS-1500 claim form is September 30, 2014. You may also refer to our notice regarding the new CMS 1500 claim form. Please contact Customer Services if you require further assistance.‚Äč

Box 21 – DIAGNOSIS OR NATURE OF ILLNESS OR INJURY – ICD INDICATOR
Use the ICD-9 or ICD-10 code for each current diagnosis applicable to that visit. Do not put any description for each diagnosis code. The new form requires that codes be entered in the correct order following the alphabetical reference numbers (A-L) codes are entered left to right (alphabetical order), 4 codes per row, and up to 3 rows. NOTE: This is different from the old CMS form where only up to 4 codes can be entered and according to the numerical order.

Example of new and old CMS 1500 claim forms

UHA recommends that the diagnosis reference numbers (A-L) be used in COLUMN 24E to correspond with the services.

“ICD IND” Use this space to indicate if the diagnosis codes being used are ICD-9 or ICD-10 codes. An indicator of “9” would represent ICD-9 codes and a “0” indicator would represent ICD-10. This is a required field.