Is anyone else having problems getting paid for O & P claims through the KY
Medicaid MCO’s? We are an out of state contracted provider. We do not have a
high volume of claims for KY Medicaid MCO’s plans. But, I have had nothing but
one problem after another getting claims paid for AFO’s & KAFO’s through all the
MCO’s. Mostly the denial reasons are “improper modifier used or modifier
missing” or “denied for medical necessity” after having submitted all the
paperwork needed for authorization.
I have claims being paid using some of the same codes and filed identical to
those being denied for reasons above. I have called one MCO and will be given a
total different explanation for denial then the reason on the claim.
If you have any suggestions as to your billing practices for filing claims to
these MCO’s that will be helpful I would greatly appreciate it. Again, primarily
these issues are with AFO’s and KAFO’s.
Sabrina
