Claims Denial Review

Using claim number 2023188DJ0166, choose the correct status of this claim.

• Reject

• Deductible

• Paid

• Open

What is the provider's name?

• Northside Hospital Gwinnett

• united community and Family Services

• Augusta VA MC

What is the members name?

• Rosselli Montalvo

• Deborah peyer

• Catherine buckwell

• Sara Wittenzellner

Using the same claim number, how many procedures are billed on this claim?

• 10

• 20

• 15

• 19

What procedures are denied by Cotiviti?

• 96375 and G0463

• J1100 and 96411

• Q5101 only

• Only G0463 (duplicate)

What is the IHT reason ("H" Code) tagging the procedures are denied?

• H80

• H91

• H39

• H40

Since the claim 2023188DJ0166 is paid, where/who will the payment be directed to?

• Payment to Subscriber (Local Plan)

• Payment to subscriber or representative payee (Processing Site)

• Payment to Subscriber (Processing Site)

Using claim 2022236CM9677, what is the denial showing?

• Mckesson/ClaimXten

• iHealth/Cotiviti

What is the IHT Reason (H Code) showing as the reason why the procedure is not paid?

• H80

• H60

• H39

• H40

Besides the "H" reason code shown in the claim, what is the complete description of the denial?

• Service exceeds the frequency limitation. The billed procedure, 90792 , was denied because it was reported more than one unit in 365 days, per our policy, which is based on CMS Policy.

• This was denied because it was covered as part of another service. Review our medical policies, located on our public website, for additional information about this medical procedure. As a reminder, the member is not responsible for the balance unless they chose to receive care from a doctor or facility not in their plan's network.

• Service is denied because it is incidental based on the National Correct Coding Initiative (NCCI) as published/maintained by CMS (Center Of Medicaid/Medicare Services). Participating providers are prohibited by contract from balance billing the member for this charge.