claim denial
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what does this mean?

  • The claim's service line 5: Diagnosis pointer value 2 points to invalid diagnosis code

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    Philip

    Hi Dawn,

    My name is Philip and I am an Insurance Specialist here at SimplePractice. While reviewing your scrubbed claim, I was able to find the cause of the error message you were receiving. If you take a look at box 24e for your fifth and sixth service lines, you can see that the Diagnosis Pointer is checked "B" for each service line but when looking at box 21 there is only one diagnosis which is located in the "A" location:

    ​​To correct this, you can click the "edit" button in the top right corner, uncheck the diagnosis pointers marked "B" and mark the "A" diagnosis. Then you can click "Save" and the claim will not run into this scrub error.

    If this client has multiple diagnoses that you would like to indicate on this claim form, you will need to enable this within your insurance settings - https://secure.simplepractice.com/practice_settings/billing_insurance - by checking the box to allow for multiple diagnosis codes.

    Please let me know if you run into any difficulties and hope you have a great day.

     

    Hi Dawn,

    My name is Philip and I am an Insurance Specialist here at SimplePractice. While reviewing your scrubbed claim, I was able to find the cause of the error message you were receiving. If you take a look at box 24e for your fifth and sixth service lines, you can see that the Diagnosis Pointer is checked "B" for each service line but when looking at box 21 there is only one diagnosis which is located in the "A" location:

    ​​To correct this, you can click the "edit" button in the top right corner, uncheck the diagnosis pointers marked "B" and mark the "A" diagnosis. Then you can click "Save" and the claim will not run into this scrub error.

    If this client has multiple diagnoses that you would like to indicate on this claim form, you will need to enable this within your insurance settings - https://secure.simplepractice.com/practice_settings/billing_insurance - by checking the box to allow for multiple diagnosis codes.

    Please let me know if you run into any difficulties and hope you have a great day.

     

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    Nadia Siddiqui

    I need to add Insurance payer, BCBS Texas but I am not able to do it. How can I add insurance payers with correct ID and address?

    Thanks

    I need to add Insurance payer, BCBS Texas but I am not able to do it. How can I add insurance payers with correct ID and address?

    Thanks

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    Gillian

    Hi Nadia, BCBS Texas is already in SimplePractice as TXBLS. Please do note that, if you're not located in Texas, you'll always want to bill to your local BCBS payer, which will then forward the claim to out-of-state BCBS plans. 

    Hi Nadia, BCBS Texas is already in SimplePractice as TXBLS. Please do note that, if you're not located in Texas, you'll always want to bill to your local BCBS payer, which will then forward the claim to out-of-state BCBS plans. 

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    Lorin Burke

    I received this message and need some clarification about what it means 

    PLEASE SUBMIT CLAIM TO LOCAL PLAN (21)

    Any assistance is appreciated 

    Thank you 

    I received this message and need some clarification about what it means 

    PLEASE SUBMIT CLAIM TO LOCAL PLAN (21)

    Any assistance is appreciated 

    Thank you 

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    Gillian

    Hi Lorin, happy to help. Some payers require that you always file to your local plan - for example, if I am a California provider filing claims with BCBS of Illinois, you'll want to enter the client's payer as BCBS of CA. BCBS of CA will then route the claim to the appropriate payer. Let me know if you have any additional questions about this, or anything else SimplePractice. I'm here to help. 

    Hi Lorin, happy to help. Some payers require that you always file to your local plan - for example, if I am a California provider filing claims with BCBS of Illinois, you'll want to enter the client's payer as BCBS of CA. BCBS of CA will then route the claim to the appropriate payer. Let me know if you have any additional questions about this, or anything else SimplePractice. I'm here to help.