How does Alliance handle claims for CCS eligible children?
Original claims for CCS eligible children (with a CCS diagnosis and/or CCS eligible condition) will be returned to you with a denial letter that includes CCSs billing instructions. A denial will also appear on a subsequent RA. The Alliances review of potential CCS claims centers on the diagnosis(es) listed by the providers office. Some offices have put inappropriate diagnosis codes on their non-CCS claims resulting in slow payments or inappropriate denials. An example of an inappropriate diagnosis would be on a visit in which a child with a CCS compound fracture case is in the office for a respiratory infection. If the compound fracture diagnosis is not relevant to the visit, then do not list the compound fracture diagnosis code on the claim. If the Alliance receives the claim with both diagnoses, it will likely result in an Alliance denial (CCS payable) even though the CCS condition of compound fracture was not relevant to the visit. If the CCS child was seen for both conditions, both
