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Second – If employer has already submitted Injury to board than we don’t have to worry about it, we can simply initial C4 to WC board thru Fax, Online Submission or thru Mail. Most Practices send Claim form thru mail which takes time to process,
There is another way to send initial submission thru Fax, which would be very easy and convenient : http://www.wcb.ny.gov/content/main/forms/Howtofax.jsp and very easy submission is thru their online portal : http://www.wcb.ny.gov/content/ebiz/WEBForms/webform_HCProvider.jsp#c4 ( User name and Pass Required)
Am Not going to talk about CODING because there are many factors related to surgery, LCD NCD NCCI edits and Coverage. When surgeon was assistant in surgery than most of the Time I use 80 81 82 and AS modifier based on above factors.
I am not saying that he/she can’t do this, they can. Some insurance process a certain claim separately for Different provider But some do not. I don’t want to say their name, but surgeons already know that which insurance is a Pain in the neck.
Carrier may deny claim saying Duplicate or saying – there is one more claim for the same patient which is already processed hence cannot process this one (they have processed this claim for Primary Surgeon)
Now, what can we do here?
We can use different envelope. In the second envelop we can send a Letter stating that this claim is for Assistant in surgery.
Sometime I send license copy of assistant surgeon along with the letter, doing this my claims denial reduced to 40%.
Many providers do not know that claims can be send Electronically, some EMR/EHR does have these capability. And you can send OP/Medical notes electronically as well. This will definitely expedite reimbursement.
Some Clerks might wanna send claim thru Fax. You can do it, But, not when DOS is not 45 days old.
My suggestion is to get in touch with Carrier and can ask for privilege for sending fax for claim submission for newer DOS instead of submitting Claim thru Mail or thru Electronic format.
Currently I am sending Fax to some carrier after taking permission. You can also do that by paying some additional fee to your responsible carrier.
I have not covered claims denials and working with WC Board and Carrier because different cases have different terms.
Have Any suggestion ……:) !