150: Payer deems the information submitted does not support this level of service
Denial Occurrences:
- This denial can occur mostly for 3 reasons,
2. Medically not necessity / Coding issue.
3. Medical Records Requested.
- Always check the remark code when working on this denial. Sometimes, the remark code provides the correct reason for denial.
On Call Scenario:
Claim denied as payers deems the information
submitted does not support this level of service
↓
May I know the exact issue?
↙ ↓ ↘
CPT has reached the Medically not necessity / Medical records
maximum allowance for Coding issue requested
a specific time period ↓ ↓
Important Notes:
- Click on the link to follow a specific scenario.
Hi
ReplyDeleteHi
DeleteActually Payer deems the information submitted does not support this level of service is occured when ER Level downgrade and for this we have to submit medical records to prove the ER services which was billed is necessary.
ReplyDeleteThanks for sharing this information and yes, you are absolutely right. But, there are other scenarios as well where this denial occurs and insurances need MR to process the claim. That is the reason for adding MR requested scenario in the above post.
DeleteAR Learning team can we submit corrected claims multiple times to the payer?
ReplyDeleteIf yes which claim number should be used lets say suppose initial claim denied we have submitted corrected claim it is also denied now which claim number needs to be mentioned 1st claim number or corrected claim processed claim number?
If the latest correction has no relation with the previous one then you can use the 1st denial claim number. But, make sure to check if the claim is within the corrected TFL or not.
DeleteClaim has two procedure codes intially one cpt code paid and one cpt code denied corrected
ReplyDeleteClaim has been sent partially only for denied cpt code it got paid then insurance recouped the amount which its has paid intially as we sent corrected claim with only one cpt what to do in this case
You will need to send the corrected claim again with the latest claim number and make sure it includes both the CPTs. This will get the payment on CPT where payment recouped and the paid CPT will not have any impact.
Delete