Need help with the rejection issue that cannot seem to be resolved...

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Jolene Feeney

• September 27, 2023 16:05

Hello, I have attempted to submit claims multiple times for a particular client. I have reviewed all possible solutions and even contacted Regence and Availity for support but it may be on the Simple Practice end. This is the message I am getting: Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.
Missing or invalid information. VALUE OF SUB-ELEMENT HEALTH CARE CODE INFORMATION-02 IS INCORRECT. EXPECTED VALUE IS FROM EXTERNAL CODE LIST - ICD-10-CM DIAGNOSIS CODE (897) AND A DECIMAL POINT SHOULD NOT BE USED. DIAGNOSIS POINTER TO THIS CODE IS REQUIRED TO PROVIDE EXACT RESULT. HEALTH CARE INFORMATION CODES IS DEFINED IN THE GUIDELINE (A3 - 21)

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  Shobha Nandivada

  • September 27, 2023 16:22

  I have similar situation. The rejection is coming from their warehouse processes. Some of the codes we use are not found here .I know my code is correct and my diagnosis code is correct but still I get rejected. I feel they don’t have all cides we use and this is very bothering for me. I feel some times to check another vendor who is more Help for us. I understand your frustration. I check
  My codes from BCB

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  Jolene Feeney

  • September 27, 2023 16:26

  Thanks Shobha, it is frustrating--I will see what other avenues I can check out. So have you been able to get a resolution to this rejection issue? I am just using an anxiety disorder code and an alcohol use disorder code (nothing too complex), and not having any other issues with other clients (at this time...).

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  Cheryl Perry

  • September 28, 2023 02:52

  You are using ICD-10 diagnosis codes and they are being rejected? I wish I could see the claim itself to get a better understanding. Can you post in the FB group without client information? I would love to try and help.

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  Kathleen Burke

  • October 01, 2023 22:39

  Not all ICD-10 codes are billable. For example, if you bill with a diagnosis of "F10.28, Alcohol dependence with other alcohol-induced disorders," the claim will be rejected because the diagnosis is not specific enough. You would have to use a sub-diagnosis such as "F10.280, Alcohol dependence with alcohol-induced anxiety disorders."

  You can use the following website to look up billable and non-billable ICD-10 codes. Those in green are billable, those in red are not. https://www.icd10data.com/ICD10CM/Codes/F01-F99 

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