*****Resolve Your Claim Denials*****

A printable pdf reference copy of this document is available at the bottom of the page.
When your claim is denied, please check ALL of the following information before you contact Barnestorm:

Referral > Demographics  Make sure patient Gender is marked
Referral > Demographics Patient date of birth should NOT be 1/1/1900
Referral > Dr + Pharmacy Make sure Primary Physician is noted and has a valid NPI number
Referral > Start Make sure the County is indicated (CBSA denial is always county)
Referral > Payers
Make sure the HIC# is valid for the payer
Codes > Other Basic Codes > Doctors
Check the NPI for the doctor, and the CA as needed.
    Correct the Doctor NPI
This article tells how:
    Cross Reference NPI to CA
This article tells how:
Codes > Rates >
Job Codes
Check the job code used on the visits for the correct HCPCS code
Billing > PPS Billing >
Edit PPS Episodes

 Check all of the information on your RAP:
- Has it been cancelled or put on hold?
- Is the from date correct?
- Is the admission date correct?
- Does the HIPPS code match?

  To correct a HIPPS code, you follow the instructions in our KB article, OASIS Correction, for correcting a KEY FIELD. http://kb.barnestorm.us/KnowledgebaseArticle50435.aspx
OASIS Correction
The from and thru dates and admission date on the initial RAP are the same. Therefore, the 0023 line item service date must also match.  http://kb.barnestorm.us/KnowledgebaseArticle50435.aspx
  Check the from and thru dates and total cert period days.
  Therapy need--correct as needed and resubmit.
Referral > Payers >
Extra Billing Info

If the error code indicates that you need a condition code, include the appropriate condition code and make sure that there are no other codes listed for that claim set date.

D0 - changes to service dates
D1 - changes in charges
D2 - changes in revenue code/HCPC
D3 - second or subsequent interim PPS bill
D4 - change in grouper input (DRG)
D5 - cancel only to correct a hic or provider number
D6 - cancel only - duplicate payment, outpatient to inpatient overlap, OIG overpayment
D7 - change to make Medicare secondary payer
D8 - change to make Medicare primary payer
D9 - any other changes.
EO- change in patient status note: if you are having trouble getting
E0 change in patient status. Note: if you are having trouble getting E0 to process and it is correctly applied to the claim please contact call center.

If D9 code is missing:
- Look up the patient in Referral and go to Payers > Extra Billing Info.
- Remove any old billing dates and any other condition codes, such as D7.
- Add a new date set to cover the current claims and make sure D9 is the only condition code listed.