Let’s all agree that claim denials are frustrating.

Often the reasons for claims denials are relatively simple.

Below are the top 3 reasons we see denied claims and how you can easily fix these errors.

1. NPI and TAX ID: Start at the beginning with your own NPI and TAX ID. If these key numbers are not on file with CENTIPEDE and your health plan then… bingo your claim won’t match the system and you’ll receive a denial as an out of network provider.

Do not use an NPI or TAX ID that was not used in your Credentialed file.

Tip: Ensure your NPI and or TAX ID change are on file with CENTIPEDE and we will notify all health plan’s accessing CENTIPEDE.

2. MEMBER NAME: Next, ensure that you have the correct and EXACT Name, Address and Date of Birth for your member that is on their ID Card.

Jack Smith is not the same as John B Smith.

Member names must be exact, take a moment to validate the name, address and date of birth on your authorization or Member ID Card.

3. DIAGNOSIS CODE: Last but not least, ensure that you have a valid Diagnosis Code with the correct number of digits. A helpful link to locate valid diagnosis is https://www.icd10data.com .

The key to clean claims starts with accurate data.

Develop a checklist and ensure that the basics are right on all of your claims.

Your browser Chrome, Internet Explorer, Firefox, Safari etc all store cookies and cache (store) pages or elements of pages to help speed up the page load process.

That’s good for speed but bad if there have been changes to a page or a site. Good practice is to clear your cookies and cache weekly just like cleaning house. Below we’ll show you how to clear cookie and cache on Chome and Internet Explorer.

CHROME: First open Chrome as your browser.

1. At the top right, click More.
2. Click More tools   Clear browsing data.
3. At the top, choose a time range. To delete everything, select All time.
4. Next to “Cookies and other site data” and “Cached images and files,” check the boxes.
5. Click Clear data.

INTERNET EXPLORER: Now Open Internet Explorer

In the upper right-hand corner of the webpage, you will see a gear button. Press this button this is your settings button.

1. Next, you will have a menu of options drop down. Select INTERNET OPTIONS from that menu.
2. Next, the INTERNET OPTIONS box is going to pop up. You are going to see 7 tabs at the top.

3. Select General Tab and then you will see Browsing history.In Browsing history, you will see a button DELETE.

4. Select the DELETE button and a new box is going to pop up. You will notice all of the boxes except for one of them are checked. Leave them checked and press the DELETE button.

5. Next, you will be brought back to the main internet options screen. Press OK and close INTERNET EXPLORER.

6. Start a NEW Session and your Cookies and Cache will be clear! 

New flexibilities have been granted by CMS and on a state-by-state basis to allow for Telehealth Billing during COVID-19 to reduce face to face interaction.

One of the new flexibilities is to allow the use of audio only for telehealth as opposed to audio and video.

For CENTIPEDE providers billing for Telehealth during COVID-19 its important to use the Place of Service Code 02.

POS 02 indicates that services were provided through a telehealth platform.

Remember to bill only those codes that are appropriate for your specialty or for which you have been granted SPECIAL flexibility.

When submitting the same HCPCS/CPT code on the same day of service for a second EVV visit, you must add Modifier 76 to the second visit.

Modifier 76 is widely used to indicate that another procedure or service was performed after the original procedure or service.

Remember each line of billing can have up to four modifiers if there is a need to add another modifier.