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<br />Attachment B <br /> <br />HEALTHCHEX <br /> <br />Entity Name: <br /> <br />Group #: <br /> <br />City of Paris <br /> <br />AP ARISOO <br /> <br />Effective Date: <br /> <br />MIIY 1. 1997 <br /> <br />Selections: <br /> <br />YES <br />[1] <br /> <br />rn <br /> <br />rn <br /> <br />rn <br /> <br />m <br /> <br />rn <br /> <br />[II <br /> <br />CODE DESCRIPTIONS AND FUNCTIONS: <br /> <br />NO <br />1>1 RULE #00 - CANNOT PROCESS <br />Whenever the claim does not have the minimum of information requiTed by the <br />system to perform its auditing functions, the claim will need to be placed on hold <br />fOT review. <br /> <br />1.1 RULE #01 - OBSOLETE CODES <br />Whenever a proceduTe code is obsolete fOT the date of service (DOS) being billed, <br />it will deny. It will be replaced with the current/suggested code if one is <br />available. <br /> <br />1...1 RULE #02 - EXPERIMENTAL PROCEDURES <br />Whenever a procedure code exclusively representing an experimental procedure <br />is billed, it will pend for Utilization Review. <br /> <br />1>1 RULE #03 - DISCRETIONARY/COSMETIC PROCEDURES <br />Whenever a procedure code considered to be cosmetic OT discretionary is billed, it <br />will pend for Utilization Review unless medically qualified. <br /> <br />Iii RULE #04 - APPROPRIATE USE OF MODIFIERS <br />Whenever a modifier is used with a procedure code which should not be used with <br />that particular modifier, the pTocedure will deny. <br /> <br />II RULE #05 - SEPARATE PROCEDURES <br />WheneveT a separate procedure, OT a procedure considered to be included in the <br />major procedure is billed, it will deny. <br /> <br />liil RULE #06 - ASSISTANT SURGERY <br />WheneveT assistant surgery is billed for a procedure that does not warrant <br />assistance, it will deny. <br />