B20 denial code description and corrective action

• This denial occurs when multiple providers billed the same service on the same DOS.

Actions

• First, we need to verify the status of the claim. This can be done by checking the status through the insurance web portal or by calling the payer.

• The most important step is to determine whether the claim denial is valid or if the insurance has denied the claim by mistake.

• Call the insurance company and confirm the information of the second claim having the same services billed for the same DOS. If the representative does not find any other claim, ask them to reprocess the claim as it was denied by mistake. Be sure to note the claim number, representative name, and call reference number, and then follow up on the claim after the provided TAT.

• If the rep provides the information of the second claim, then we check our system to see whether the second claim is present or not.

• If we also find the second claim in our system from another provider, then we submit a corrected claim with modifier 77.

• Medicare does not accept corrected claims, so in the case of any denial, a new claim must always be submitted.

• If we do not have the claim in our system and the provider on the second claim is not related to our group, then we proceed with submitting an appeal or follow practice SOPs or client suggestions.

• For submitting an appeal/corrected claim, must calculate the timely filing limit starting from the processed date. If the limit has been exceeded, the claim will be denied again for exceeding the filing deadline. In such cases, we should consult with the provider. Some clients may still want us to submit the appeal/corrected claim even after the timely filing limit has passed, so we should proceed according to their instructions.

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