Queries: Rejected Claims for Medicare DME to Novitas Solutions
Has anyone had recent issues with rejections of claims for DME products (i.e. L4360 CAM walker) We have been submitting these claims with laterality and KX modifiers, now out of nowhere they are rejected saying invalid information as specified in status details . We have tried new modifier combos, just -RT or-LT, just- KX, added -NU, none work . We called them and they said modifiers are incorrect but would not tell us what to use since that info is locked up with the nuclear codes. If something has changed they never informed us. Anyone else with the same issue or any suggestion appreciated.
Larry Goldstein, DPM, Warner Robins, GA
This issue was partly due to the confusion of the provider and incorrect information in the claim. Both of which resulted in a front end rejection.
The provider thought it was "their own" clearinghouse but in fact it was CEDI=Common Electronic Data Interchange, which is the DME MAC clearinghouse which
rejected the claim.
Thus it was Medicare's own clearinghouse which was not at fault but actually where the front end rejection took place.
A front end rejection indicates that Medicare cannot process a claim as is, due to a severe fault with the claim, resulting in the claim not being processable or appealable as submitted.
Some examples, incorrect information in the Common Work File vs. what the claim contains. This could have included wrong DOB, name spelling vs. MBI, etc. Others include wrong "other insurance information". Reaching out to CGS ombudsmen, it turned out to be the latter. Dr. Goldstein was contacted and the claims were corrected and resubmitted and currently processing. Stay tuned for future follow ups.