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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2014

Reminders for Better Claims Processing


Harvard Pilgrim evaluates our claims processing on an ongoing basis, identifying opportunities for improvement and making enhancements.  Through this process, we also identify common claims submission errors and areas in which providers may not be aware of our claims coding requirements. With this in mind, we offer the following tips to aid in accurate processing and minimize the chances of having your claims pended or denied:

  • When billing a bilateral service, please remember to bill on a single claim line with modifier 50. Bilateral services are procedures performed on both sides of the body during the same operative session or on the same day. For more information, please see our Bilateral Services and CPT Modifier-50 Payment Policy.
  • When billing an unclassified drug code, please submit an NDC number along with the unlisted J code. For more information, please see our Unlisted and Unspecified Procedure Codes Payment Policy.
  • Harvard Pilgrim requires two-digit HCPCS ambulance service modifiers be submitted in the first modifier field for all ambulance services with the exception of HCPCS code A0998. Absence of the two-digit HCPCS ambulance service modifier will cause your claim to deny. Please combine one-digit modifiers to form a two-digit modifier (the first digit identifies the ambulance’s place of origin; the second digit identifies the destination) and bill using the appropriate two-digit HCPCS ambulance service modifier. For more guidance, please refer to the Ambulance Transport Payment Policy.

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Reminders for Better Claims Processing

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,
Editor

Kristin Edmonston,
Production Coordinator