We review claims for the following edits:

236 - This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.

97 - The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. | | Upcoding | 002 | 150 - Payer deems the information submitted does not support this level of service. | | Duplicate charge | 003 | 18 - Exact duplicate claim/service | | Incorrect quantity | 004 | 57 - Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this day's supply. | | Incorrect code | 005 | 65 - Procedure code was incorrect. This payment reflects the correct code. | | Procedure not documented | 006 | B12 - Services not documented in patient's medical records. | | Medically unnecessary | 006 | 50 - These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

RARC N842 - Patient cannot be billed for charges. |

Where codes are placed on the 837 is configurable — discuss with your Goodbill contact.