Medscheme Claim Rejections

In light of recent system enhancements that have been implemented to successfully respond to a changing business environment, we have consequently noticed an increase in the number of claim rejections within the business.

We have detected a specific trend and recommend that you remain cognizant of the rejections highlighted below. 

No Referring Provider practice number submitted
We have seen an increase in claims rejecting for ‘No referring provider practice number submitted’. This will apply to claim(s) where no referring provider practice number was submitted, or, where the referring provider practice number is submitted on line level instead of correctly reflecting at header level.

Billing and sequencing of modifiers
It is crucial that modifiers are submitted on the claim/s, in the correct sequence, to avoid unnecessary rejections. It is common knowledge that the application and the calculation of the final rand value on payment of claims, which have modifiers attached, is complex.

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