Preview

Case Study: Hi Darnita

Satisfactory Essays
Open Document
Open Document
72 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Case Study: Hi Darnita
Hi Darnita,

Could you please review this issue? I originally thought the issue was the agreement, however the correct agreement has been attached. Codes 99395. 99395 when billed with code Z01419 for routine gynecological exam visit for members with IAFPWV00 benefits is denying. Do you know if there’s an issue of your end or can you tell me if the provider is billing incorrectly. Please see below. This is a state complaint.

You May Also Find These Documents Helpful

  • Good Essays

    In this case, authorization was provided for the services, although under the incorrect patient information. Considering that SelectCare was promptly notified of the mistake, and that had the correct patient information been given, authorization would have been provided for the medically necessary services for patient E.F., the purported lack of authorization does not support denial of this claim. Indeed, it was no more than a technical default that caused no prejudice to SelectCare. See Koehler v. Aetna Health Inc., 683 F.3d 182, 188 (5th Cir. 2012) (recognizing that a lack of preauthorization “does not prejudice [the insurer]’s ability to refuse coverage if it concludes that the services were not medically necessary”); Weaver v. Phoenix Home Life Mut. Ins. Co., 990 F.2d 154, 158-59 (4th Cir. 1993) (reversing plan administrator’s denial of coverage because its denial that “hospital confinement commencing 05/16/90 was not authorized” was conclusory and the medical necessity of the inpatient stay, not any authorization of it, was what determined coverage). Under these circumstances, Medical City is entitled to payment in full for its services in the amount of $74,404.44. Demand is made for payment of this…

    • 802 Words
    • 4 Pages
    Good Essays
  • Good Essays

    Case Study 4

    • 1348 Words
    • 5 Pages

    1. What condition or conditions (disease/diseases) could Harry have as described in this case? Which one would be your primary diagnosis? In a very general explanation, describe this condition/disease. (1 point)…

    • 1348 Words
    • 5 Pages
    Good Essays
  • Satisfactory Essays

    Ime Report Sample

    • 277 Words
    • 2 Pages

    Requested verification from the provider’s office on the number of visits attended to date; however, no callback/report was received prior to the submission of this request to PA.…

    • 277 Words
    • 2 Pages
    Satisfactory Essays
  • Better Essays

    Case StudyI

    • 718 Words
    • 3 Pages

    The article, “The NYSEG Corporate Responsibility Program” (Beauchamp, T. L., Bowie, N. E., & Arnold, D. G., 2009) is a writing that addresses the social responsibility program of a major energy provider in the Northeastern United States. The article discusses the implications of a corporation that has addressed the need to be ethical and instill a corporate responsibility policy. The author attempts to present all problems and concerns that are present with a company that has decided to act in an ethical manner. The company has created a large commitment to the community. They have agreed to assist in providing services to the less fortunate. The article is clear and concise. The reader is able to understand the major issues of social responsibility that face the corporation and the costs involved. NYSEG must assess the amount of financial commitment that the company can present to Project Share. They have agreed to assist in funding but must consider the ultimate cost of lower profits to the shareholders. The firm must decide at what point social responsibility begins and social work ends.…

    • 718 Words
    • 3 Pages
    Better Essays
  • Satisfactory Essays

    Hi Tameria Case Study

    • 103 Words
    • 1 Page

    I do understand, however do I have to do anything more to be accepted in to the program. Do I need to apologize to Terri Stubblefield for the misunderstanding of the termination. I am trying very hard to comply with the policies of the termination of the School of Social Work program. Also, I am waiting on my teacher in SOC 5410- Marriage and Families to confirm my participation in her class. Ms. Elizabeth Pare said in her announcement she has confirm all students participation that were in class last week, however mines said waiting Ms. Pare confirming participation currently..…

    • 103 Words
    • 1 Page
    Satisfactory Essays
  • Satisfactory Essays

    case study 3

    • 665 Words
    • 3 Pages

    IgG – funtions in neutralizing, opsonation, compliment activation, antibody dependent cell-mediated cytocity, neonatal immunity, and feedback inhibition of B-cells and found in the blood.…

    • 665 Words
    • 3 Pages
    Satisfactory Essays
  • Better Essays

    Case Study 4

    • 1050 Words
    • 5 Pages

    -Do you find yourself worrying constantly about a variety of different things at one time?…

    • 1050 Words
    • 5 Pages
    Better Essays
  • Good Essays

    Steven Lauder, SIU Investigator for Aetna Life Insurance submitted a complaint to Missouri Department of Insurance alleging a review of billing invoices over a 12 month period, revealed codes 92225 and 92226 were submitted a total of 341 times for 57 patients and that many patients were noted to have had billing code 9226 submitted 10 to 12 times in a 12 month period.…

    • 904 Words
    • 4 Pages
    Good Essays
  • Satisfactory Essays

    Hi Tama Case Study

    • 96 Words
    • 1 Page

    Hi Tamela, great post. You made great points on the different questions we need to ask the patient. I agree with you that she might be experiencing the side effects of the medication. There are times that the patient just take the medication as ordered by the physician but don’t know about the side effects. It is indeed important to educate our patients regarding the possible side effects, drug-drug interactions, herbal-drug interactions, or food-drug interactions. Due to S.P.’s history of MI, it is important that her hypertension and hyperlipidemia be manage properly to prevent recurrent…

    • 96 Words
    • 1 Page
    Satisfactory Essays
  • Satisfactory Essays

    Hi Shrikant Case Study

    • 66 Words
    • 1 Page

    As per my understanding for the DCR 70042 ,I have created the Initial draft for the test plan.…

    • 66 Words
    • 1 Page
    Satisfactory Essays
  • Good Essays

    Assigning EM Codes

    • 443 Words
    • 2 Pages

    This is an office visit for a new patient with a comprehensive history and physical exam. The code range for new patients is 99201 to 99205. There is a consultation code which range from 99241 to 99255. But in 2010 Medicare announced that they would stop paying for consult codes. This code has to be documented in the patient’s records though. (McGraw-Hill, 2012) The correct code for comprehensive history and physical examination with high decision making would be 99205.…

    • 443 Words
    • 2 Pages
    Good Essays
  • Satisfactory Essays

    Case Study 2

    • 1188 Words
    • 30 Pages

    1. Create and interpret Commonwealth’s statement of cash flows for 2013. What information does it provide regarding the HMO’s sources and uses of cash over the past year?…

    • 1188 Words
    • 30 Pages
    Satisfactory Essays
  • Satisfactory Essays

    Case Study 2

    • 436 Words
    • 2 Pages

    Yet again write everything down, If you do ask the couple anything Write down what they say, Dont lead them, let them, tell you what they know, Dont touch anything, Dont touch the money,…

    • 436 Words
    • 2 Pages
    Satisfactory Essays
  • Satisfactory Essays

    Left Knee Case Summary

    • 401 Words
    • 2 Pages

    Requested verification from the provider’s office on the IW’s height and weight; however, no callback/report was received prior to the submission of this request to…

    • 401 Words
    • 2 Pages
    Satisfactory Essays
  • Satisfactory Essays

    Bo Jackson

    • 687 Words
    • 3 Pages

    Everyone has a favorite athlete that they admire watching as they grow up. But my favorite athlete is a athlete that I was never able to see play. His name is Vincent Edward Jackson better known as Bo Jackson. He was born on November 30, 1962 in Bessemer, Alabama. Jackson came to fame as a multi-talented athlete, who excelled in baseball, football and track at an early age. His superior athletic abilities memorized me in ways that no other athlete has. He had a body of a Greek God and a personality of a church mouse. Bo’s athletic tenure was so brief; he played professional football and baseball for less than 10 years.…

    • 687 Words
    • 3 Pages
    Satisfactory Essays