49: This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam

Reason for Occurrence:

• This denial occurs when a claim is billed with a routine diagnosis.
• Diagnosis codes that start with 'Z' are routine diagnosis codes.
• This can be resolved when the routine diagnosis is changed with another proper diagnosis code.

On Call Scenario:

                                              Claim denied as routine services not covered
                                                                             ↓
                                                         May I get the denial date?
                                                                             ↓

                                          What is the time limit to send a corrected claim?

                                                                             ↓

                                              What is the Fax# or Mailing address to send

                                                                     an appeal?

                                                                             ↓

                                                         How much is the time limit

                                                              to send an appeal?

                                                                             ↓

                                                    May I have the claim# & call ref#         

Important Note:

• This denial should be assigned to the coding team to review and provide the correct dx code and once a response is received with the correct dx details then send the corrected claim to insurance by updating the correct dx code even if the time limit to send the correct claim is crossed.
• If the coding team states that the dx code is correct then bill the claim to the patient or secondary payer since routine service is not covered under the patient plan and is the patient's responsibility.
• Before billing the claim to a Secondary or Consecutive payer, need to verify the eligibility of the patient for a secondary or consecutive payer.
• To verify the eligibility of secondary or consecutive payer, check the payer website if access is available or else call the insurance.
• If a patient policy is active for secondary or consecutive payers on DOS then bill the claim.
• If no other payer is active or available on DOS then released the claim to the patient.
• Sometimes, the client wants us to send an appeal to insurance instead of releasing it to the patient, so work accordingly.
• When sending an appeal, calculate the time limit from the denial date, if it is not crossed then send the appeal, or else write off the claim if the time limit is crossed.
• Sometimes the client wants us to send the appeal even if the time limit is crossed, so work accordingly.

Prepare Notes:

Source of Status:

* Call Website EOB System

Clearing House Comment (Please make the changes if required):

Insurance Name:

*

Clearing House Name:

Insurance Phone#:

*

Rep Name:

*

Website Name:

*

Denial Date:

*

Mention Routine Diagnosis:

*

What Information is Available?:

* Corrected Claim Time Frame Appeal Information Corrected Claim Time Frame and Appeal Information None

Corrected Claim Time:

*

Mode of appeal:

* Fax Mail Website

Fax Number:

*

Website Link:

*

Mailing Address:

*

Appeal Limit:

*

Additional Comment:

Claim Number:

*

Call Reference#

*

Action:

* Need coding assistance Updated correct modifier and resubmitted the claim Updated correct CPT and resubmitted the claim Updated correct DX and resubmitted the claim Need client assistance Need to send an appeal Need to allow time Appeal Sent



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