Inappropriate Primary Diagnosis — Denials for Unacceptable Primary/Principal, Manifestation, and Sequela Diagnoses
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Notifies providers that Meridian will deny or limit claims billed with unacceptable primary/principal, manifestation, or sequela diagnosis codes in outpatient or inpatient facility settings for Medicaid lines of business.
Meridian will deny or limit claims billed with unacceptable primary/principal, manifestation, and sequela diagnosis codes in outpatient or inpatient facilities.
Denial Criteria Overview
inv-01: Denial criteria overview — Claims criteria
Claims criteria:
Diagnosis Types Targeted
| No codes listed |
Denial Policy and Provider Impact
Denial for inappropriate primary/principal, manifestation, or sequela diagnosis
Claims will be denied when billed with unacceptable primary/principal diagnosis, manifestation diagnosis, or sequela diagnosis in outpatient or inpatient facilities. This policy applies to Meridian Medicaid lines of business and is effective on or after 8/1/2023.
- Denials are based on correct coding guidelines supported by CMS and ICD-10.
- Applies to outpatient and inpatient facility settings for Medicaid.
- Effective on or after 8/1/2023.
Key Term: Inappropriate Primary Diagnosis
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