No Surprises Act (NSA) and TDI Independent Dispute Resolution Mediation
The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It also establishes an independent dispute resolution process...
Qualifying Payment Amount (QPA), How QPA is Calculated
The qualifying payment amount (QPA) is the basis for determining individual cost sharing for items and services covered by the balance-billing protections in the No Surprises Act (NSA), under certain circumstances. Cost-sharing for emergency items and services and non-emergency items and services furnished by an out-of-network provider in an...
NSA and Balance Billing Laws by State
No Surprises Act (NSA) established new federal protections against surprise medical bills and balance billing, which took effect on 1st Jan, 2022. State-regulated insurance plan (such as employer-sponsored commercial plans): If that state already has a balance billing law deemed by the federal government as meeting certain criteria, the state...
No Surprises Act (NSA), Federal IDR and how it works?
The 2020 No Surprises Act (NSA) established new federal protections against surprise medical bills and balance billing, which took effect on January 1, 2022. For emergency patients visiting a hospital or freestanding emergency room under a state-regulated insurance plan (such as employer-sponsored commercial plans): If that state already has a...
The No Surprises Act and What It Means for Emergency Rooms
The 2020 No Surprises Act (NSA) established new federal protections against surprise medical bills and balance billing, most of which took effect January 1, 2022. Below is a summary of the major No Surprises Act requirements and what they mean for you. 1- Prohibits balance billing for out-of-network emergency care (provided...
Ultrasound CPT Codes 2022
Diagnostic Ultrasound Procedures CPT Code range 76506- 76999. The Current Procedural Terminology (CPT) code range for Diagnostic Ultrasound Procedures 76506-76999 is a medical code set maintained by the American Medical Association. Ultrasound CPT Codes Range: 76506-76536 - Diagnostic Ultrasound Procedures of the Head and Neck 76604-76642 - Diagnostic Ultrasound Procedures of the...
Understand and Recognize the Types of CPT Codes 2022
What are CPT Codes? Current Procedural Terminology, more commonly known as CPT codes, refers to a set of medical codes used by physicians/providers, non-physician practitioners, hospitals, outpatient facilities, and laboratories to describe the procedures and services they perform. Specifically, CPT codes are used to report procedures and services to federal and...
CO 6 Denial: The procedure code is inconsistent with the patient's age
  CO 6 Denial Code: The procedure/revenue code is inconsistent with the patient's age When the claim says CO 6 Denial Code – The Procedure/revenue code is inconsistent with the patient’s age, it means claim denied as the CPT code or revenue code billed is not compatible with patient age. Let us...
Denial Code CO 204 - Not Covered under the Patient's current benefits plan
  Denial Code CO 204 - Not Covered under the Patient's current benefits plan   With a valid Advance Beneficiary Notice (ABN): PR-204: This service, equipment and/or drug is not covered under the patient's current benefit plan PR-N130: Consult plan benefit documents/guidelines for information about restrictions for this service Without a valid ABN: ...
CO 119 - Benefit Maximum for this Time Period has been Reached
  (MEDICARE DOES NOT PAY FOR THIS MANY SERVICES OR SUPPLIES) CO -119 Benefit maximum for this time period or occurrence has been reached. Check Benefit Information through website/Calls If NO - Call the carrier and send the claim back to reprocess. PR - 119 Benefit maximum for this time period or occurrence has...