Prof. Claims Add Modifiers to Services/Procedures/other Codes of a Claim

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The following are the mapping for submitting modifiers. In an instance where a code needs to be added to a claim, a corrected claim should be submitted. This would require the claim frequency code '7' to be submitted, and the payer claim control number must be included on the claim in the claimControlNumber field in the claimSupplementalInformation. The claimControlNumber is the number assigned by the payer to identify a claim. Once submitted, payers will review the claim and make any changes based on their internal review. For more information, see the API Examples section on the left panel in the developer portal.

ProfessionalService:  
      required:  
        - compositeDiagnosisCodePointers  
        - lineItemChargeAmount  
        - measurementUnit  
        - procedureCode  
        - procedureIdentifier  
        - serviceUnitCount  
      type: object  
      properties:  
        procedureIdentifier:  
          type: string  
          description: >-  
            Loop: 2400, Segment: SV1, Element: SV101-01, Notes: Allowed Values are: 

- 'ER' Jurisdiction Specific Procedure and Supply Codes, 
- 'HC' Health Care Financing Administration Common Procedural Coding System  
   (HCPCS) Codes, 'IV' Home Infusion EDI Coalition (HIEC) Product/Service Code,'WK' Advanced Billing Concepts (ABC) Codes  
   example: HC  
   enum:  
      - ER  
      - HC  
      - IV  
      - WK  
    procedureCode:  
      - type: string  
      - description: 'Loop 2400, Segment: SV1, Element: SV101-02'  
      - example: E0570  
     procedureModifiers:  
      - maxItems: 4  
      - minItems: 0  
      - type: array  
      -  description: >-  
              Loop 2400, Segment: SV1, Elements: SV101-03 to SV101-06, Notes:  
              Required when modifier clarifies or improves the reporting accuracy  
              of the associated procedure code. If not required then do not send  
     items:  
      -  type: string  
     description:  
      -  type: string
      -  description: >-  
            Loop 2400, Segment: SV1, Element: SV101-07, Notes: A free form  
            description to clarify teh related data elements and their content

Updated 3 months ago