21: This injury/illness is the liability of the no-fault carrier
On Call Scenario:
Claim denied as This injury/illness
is the liability of the No-fault
carrier/Auto insurance
↓
May I get the denial date?
↓
Could you please provide the
No-fault carrier/Auto insurance details?
↓
Does rep have the details?
↙ ↘
Yes No
↙ ↘
What is the name, policy id, May I have the
payer id & mailing address of claim# & call ref#?
Claim denied as This injury/illness
is the liability of the No-fault
carrier/Auto insurance
↓
May I get the denial date?
↓
Could you please provide the
No-fault carrier/Auto insurance details?
↓
Does rep have the details?
↙ ↘
Yes No
↙ ↘
What is the name, policy id, May I have the
payer id & mailing address of claim# & call ref#?
No-fault carrier/Auto insurance?
↓
May I have the claim# & call ref#?
Important Note:
- If the rep does not have No-fault/Auto carrier details then check in the system if there is any Auto insurance available or patient payment history has any Auto insurance as primary, if yes then resubmit the claim to that payer or else release the claim to the patient if Auto insurance information is not available.
- You can also check the payer web portal to get the auto insurance details if access is available.
- When the rep provides all the details of the No-fault/Auto carrier then you can update that insurance as primary and resubmit the claim to primary insurance. Do not keep commercial payer as secondary insurance.
- Medicare can be kept as secondary insurance and when the No-fault/Auto carrier leaves the balance as patient responsibility then bill to medicare after updating the MSP code.
Prepare Notes:
Source of Status:
Clearing House Comment (Please make the changes if required):
Insurance Name:
Clearing House Name:
Insurance Phone#:
Rep Name:
Website Name:
Denial Date:
Did rep have the no-fault/auto insurance info?/Is no-fault/auto insurance info?:
Name of the no-fault/auto insurance:
What are the other infomration available/provided by rep:
Policy ID:
Payer ID:
Claim Mailing Address:
Additional Comment:
Claim Number:
Call Reference#
Action:
In the below box, final notes will be displayed once you click on Submit button and this box is editable, so you can make the changes as per the requirement
Note: We are not saving any of your inputs or notes in the backend
If rep don't provide and we also can not find insurance what we need to do
ReplyDeleteThe balance amount can be billed to the patient. The patient will provide the liability carrier details if have or else need to pay the amount.
Deleteso health insurance does not cover injury/illness from a car accident in general? even if the patient has health insurance, we don't get to bill it because of that? Also is there a workaround in the dx code for us to be able to bill health insurance? given there is no medicaid. And on another case, if there's no liability insurance, just medicaid, can I bill medicaid as primary? Please bear with my questions thanks
ReplyDeleteIf you will bill such claim to health insurance or Medicaid then they will deny the claim stating this is an auto insurance responsibility. So, the claim must be billed to Auto insurance.
DeleteOn the other hand, it is necessary for US citizen to have an auto insurance policy if driving a vehicle.
thank you
Delete👍
DeleteWe were denied coverage because Medicare stated, "This injury/illness is the liability of the no-fault carrier." However, the claim is not related to auto insurance. What can we do now?
ReplyDeleteIt could be for the below possible reasons,
Delete1. The patient condition on CMS1500 form on box 10 or the condition code on the UB04 form is updated as accident-related.
2. Dx code is accident-related.
If the above 2 points are accurate then you can connect with Medicare rep to get the claim reprocessed.
Where can we find dagnosis code cover in on-fault or not
ReplyDelete