We will always go to bat for the patient. Our goal is not to deny care, but to deny inaccurate claims. In fact, only 99.3% of our denials are refiled or appealed, because we take an intelligent and holistic approach to reviewing claims as accurately as possible.
In this week’s claim of the week, a four-month-old infant went in for a developmental follow-up exam. The provider then charged for 2 level 4 E&M codes. After reviewing the records, not only were the level 4 codes not supported, but the records show that they did not actually perform the tests listed. The infant still got the care they needed and the member was not balance billed.