Medicaid Denials and Action

Denial - 0660 Calculated payment equals zero. Other insurance paid more than Medicaid Allowable.
Action: Adjusted the claim (Medicaid write off)

Denial - 2091 Recipient services covered by HMO plan
Action: Claim would be filed to Medicaid HMO's

Denial - 0142 Claim exceeds 12 month filing limit
Action: Claim appealed with Clearing house acceptance report

Denial - 0312 Referring provider required for this procedure in field 17A/19.
Action: Issue raised to calling team regarding the PCP info after that updated the info with dummy#000000100 and refiled the claim.

Denial - 2346 Referring provider number not on file.
Action: Dummy#000000100 updated in 17A and refiled the claim.

Denial - 4888 NDC Missing/Invalid
Action: NDC# updated in claim note and refiled the claim.

Denial - 0721 Recipient ineligible for date of service
Action: After Medicaid eligibility, if the patient have other active insurance claim filed to other carrier. If patient have no other coverage bill to patient.

Denial - 0720 Medicare coverage is present
Action: After Medicare verification claim filed to Medicare.

Denial - 4257 Invalid procedure code modifier
Action: Removed modifier and refiled the claim.

Denial - 4801 These services cannot be billed on this claim form or the provider type listed for this provider number cannot file this type of claim.
Action: Normally G codes denied for this reason. After Medicare payment claim has been adjusted.