Laserfiche WebLink
<br />Addendum B <br /> <br />HEALTHCHEX <br /> <br />CITY OF PARIS <br />APAnSOl <br /> <br />Entity Name: <br />Group #: <br /> <br />Effective Date: 5/1/03 <br /> <br />Selections: CODE DESCRIPTIONS AND FUNCTIONS: <br /> <br />YES <br />[iJ <br /> <br />[iJ <br /> <br />[!] <br /> <br />[!] <br /> <br />m <br /> <br />[!] <br /> <br />[!] <br /> <br />NO <br />D RULE #00 - CANNOT PROCESS <br />Whenever the claim does not have the minimum of information required by the <br />system to perform its auditing functions, the claim will need to be placed on hold <br />for review. <br /> <br />D RULE #01 - OBSOLETE CODES <br />Whenever a procedure code is obsolete for the date of service (DOS) being billed, <br />it will deny. It will be replaced with the current/suggested code if one is available. <br /> <br />D RULE #02 - EXPERIMENTAL PROCEDURES <br />Whenever a procedure code exclusively representing an experimental procedure is <br />billed, it will pend for Utilization Review. <br /> <br />D RULE #03. DISCRETIONARY/COSMETIC PROCEDURES <br />Whenever a procedure code considered to be cosmetic or discretionary is billed, it <br />will pend for Utilization Review unless medically qualified. <br /> <br />D RULE #04 - APPROPRIATE USE OF MODIFIERS <br />Whenever a modifier is used with a procedllre code which should not be used with <br />that particular modifier, the procedure will deny. <br /> <br />D RULE#05-SEPARATEPROCEDURES <br />Whenever a separate procedure, or a procedure considered to be included in the <br />major procedure is billed, it will deny. <br /> <br />D RULE #06 - ASSIST ANT SURGERY <br />Whenever assistant surgery is billed for a procedure that does not warrant <br />assistance, it will deny. <br />