Do claim administrators report medical bills that are denied?
Yes, denied medical bills are reportable. The requirement is for the payer to report the detailed medical payment records with a zero in the total amount paid per bill (DN516), if the entire bill is denied. The payer reports the bill adjustment group code (DN543) and the bill adjustment reason code (DN544) in the 2320 CAS segment indicating the reason for the denial. For any line that is denied on a bill, the total amount paid per line (DN574) is equal to zero. The payer reports the service adjustment group code (DN731) and the service adjustment reason code (DN732) in the 2430 CAS segment indicating the reason for the denial.
Related Questions
- When my claim was denied, I submitted my medical bills to my private health insurance carrier. What happens to the money that my health insurance company has paid?
- Should a hospital report to the Board that a new applicant to the medical staff has been denied appointment?
- I have medical bills to submit to Aetna Student Health. Where do I get claim forms?
