BlueCross BlueShield Claim Adjustment Reason Codes

A while back, we had a number of therapists looking for the BCBS Claim Adjustment Reason Code listing. Claim adjustment reason codes communicate why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code.

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1 Deductible Amount Start: 01/01/1995 2 Coinsurance Amount Start: 01/01/1995 3 Co-payment Amount Start: 01/01/1995 4 The procedure code is inconsistent with the modifier used or a required modifier is missing. This change to be effective 7/1/2010: The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 5 The procedure code/bill type is inconsistent with the place of service. This change to be effective 7/1/2010: The procedure code/bill type is inconsistent with the place of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 6 The procedure/revenue code is inconsistent with the patient's age.This change to be effective 7/1/2010: The procedure/revenue code is inconsistent with the patient's age. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 7 The procedure/revenue code is inconsistent with the patient's gender. This change to be effective 7/1/2010: The procedure/revenue code is inconsistent with the patient's gender. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 8 The procedure code is inconsistent with the provider type/specialty (taxonomy). This change to be effective 7/1/2010: The procedure code is inconsistent with the provider type/specialty (taxonomy). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 9 The diagnosis is inconsistent with the patient's age. This change to be effective 7/1/2010: The diagnosis is inconsistent with the patient's age. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 10 The diagnosis is inconsistent with the patient's gender. This change to be effective 7/1/2010: The diagnosis is inconsistent with the patient's gender. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 11 The diagnosis is inconsistent with the procedure. This change to be effective 7/1/2010: The diagnosis is inconsistent with the procedure. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 12 The diagnosis is inconsistent with the provider type. This change to be effective 7/1/2010: The diagnosis is inconsistent with the provider type. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 13 The date of death precedes the date of service. Start: 01/01/1995 14 The date of birth follows the date of service. Start: 01/01/1995 15 The authorization number is missing, invalid, or does not apply to the billed services or provider. Start: 01/01/1995 | Last Modified: 09/30/2007 16 Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 01/01/1995 | Last Modified: 09/20/2009 17 Requested information was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 | Last Modified: 09/21/2008 | Stop: 07/01/2009 18 Duplicate claim/service. Start: 01/01/1995 19 This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier. Start: 01/01/1995 | Last Modified: 09/30/2007 20 This injury/illness is covered by the liability carrier. Start: 01/01/1995 | Last Modified: 09/30/2007 21 This injury/illness is the liability of the no-fault carrier. Start: 01/01/1995 | Last Modified: 09/30/2007 22 This care may be covered by another payer per coordination of benefits. Start: 01/01/1995 | Last Modified: 09/30/2007 23 The impact of prior payer(s) adjudication including payments and/or adjustments. Start: 01/01/1995 | Last Modified: 09/30/2007 24 Charges are covered under a capitation agreement/managed care plan. Start: 01/01/1995 | Last Modified: 09/30/2007 25 Payment denied. Your Stop loss deductible has not been met. Start: 01/01/1995 | Stop: 04/01/2008 26 Expenses incurred prior to coverage. Start: 01/01/1995 27 Expenses incurred after coverage terminated. Start: 01/01/1995 28 Coverage not in effect at the time the service was provided. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Redundant to codes 26&27. 29 The time limit for filing has expired. Start: 01/01/1995 30 Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. Start: 01/01/1995 | Stop: 02/01/2006 31 Patient cannot be identified as our insured. Start: 01/01/1995 | Last Modified: 09/30/2007 32 Our records indicate that this dependent is not an eligible dependent as defined. Start: 01/01/1995 33 Insured has no dependent coverage. Start: 01/01/1995 | Last Modified: 09/30/2007 34 Insured has no coverage for newborns. Start: 01/01/1995 | Last Modified: 09/30/2007 35 Lifetime benefit maximum has been reached. Start: 01/01/1995 | Last Modified: 10/31/2002 36 Balance does not exceed co-payment amount. Start: 01/01/1995 | Stop: 10/16/2003 37 Balance does not exceed deductible. Start: 01/01/1995 | Stop: 10/16/2003 38 Services not provided or authorized by designated (network/primary care) providers. Start: 01/01/1995 | Last Modified: 06/30/2003 39 Services denied at the time authorization/pre-certification was requested. Start: 01/01/1995 40 Charges do not meet qualifications for emergent/urgent care. This change to be effective 04/01/2010: Charges do not meet qualifications for emergent/urgent care. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. This change to be effective 07/01/2010: Charges do not meet qualifications for emergent/urgent care. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 41 Discount agreed to in Preferred Provider contract. Start: 01/01/1995 | Stop: 10/16/2003 42 Charges exceed our fee schedule or maximum allowable amount. (Use CARC 45) Start: 01/01/1995 | Last Modified: 10/31/2006 | Stop: 06/01/2007 43 Gramm-Rudman reduction. Start: 01/01/1995 | Stop: 07/01/2006 44 Prompt-pay discount. Start: 01/01/1995 45 Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use Group Codes PR or CO depending upon liability). Start: 01/01/1995 | Last Modified: 10/31/2006 46 This (these) service(s) is (are) not covered. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 96. 47 This (these) diagnosis(es) is (are) not covered, missing, or are invalid. Start: 01/01/1995 | Stop: 02/01/2006 48 This (these) procedure(s) is (are) not covered. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 96. 49 These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. This change to be effective 7/1/2010: These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 50 These are non-covered services because this is not deemed a 'medical necessity' by the payer. This change to be effective 07/01/2010: These are non-covered services because this is not deemed a 'medical necessity' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 51 These are non-covered services because this is a pre-existing condition. This change to be effective 7/1/2010: These are non-covered services because this is a pre-existing condition. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 52 The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. Start: 01/01/1995 | Stop: 02/01/2006 53 Services by an immediate relative or a member of the same household are not covered. Start: 01/01/1995 54 Multiple physicians/assistants are not covered in this case. This change to be effective 07/01/2010: Multiple physicians/assistants are not covered in this case. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 55 Procedure/treatment is deemed experimental/investigational by the payer. This change to be effective 07/01/2010: Procedure/treatment is deemed experimental/investigational by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 56 Procedure/treatment has not been deemed 'proven to be effective' by the payer. This change to be effective 7/1/2010: Procedure/treatment has not been deemed 'proven to be effective' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 57 Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this day's supply. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Split into codes 150, 151, 152, 153 and 154. 58 Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. This change to be effective 07/01/2010: Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 59 Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) This change to be effective 07/01/2010: Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 60 Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services. Start: 01/01/1995 | Last Modified: 06/01/2008 61 Penalty for failure to obtain second surgical opinion. This change to be effective 7/1/2010: Penalty for failure to obtain second surgical opinion. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 62 Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. Start: 01/01/1995 | Last Modified: 10/31/2006 | Stop: 04/01/2007 63 Correction to a prior claim. Start: 01/01/1995 | Stop: 10/16/2003 64 Denial reversed per Medical Review. Start: 01/01/1995 | Stop: 10/16/2003 65 Procedure code was incorrect. This payment reflects the correct code. Start: 01/01/1995 | Stop: 10/16/2003 66 Blood Deductible. Start: 01/01/1995 67 Lifetime reserve days. (Handled in QTY, QTY01=LA) Start: 01/01/1995 | Stop: 10/16/2003 68 DRG weight. (Handled in CLP12) Start: 01/01/1995 | Stop: 10/16/2003 69 Day outlier amount. Start: 01/01/1995 70 Cost outlier - Adjustment to compensate for additional costs. Start: 01/01/1995 | Last Modified: 06/30/2001 71 Primary Payer amount. Start: 01/01/1995 | Stop: 06/30/2000 Notes: Use code 23. 72 Coinsurance day. (Handled in QTY, QTY01=CD) Start: 01/01/1995 | Stop: 10/16/2003 73 Administrative days. Start: 01/01/1995 | Stop: 10/16/2003 74 Indirect Medical Education Adjustment. Start: 01/01/1995 75 Direct Medical Education Adjustment. Start: 01/01/1995 76 Disproportionate Share Adjustment. Start: 01/01/1995 77 Covered days. (Handled in QTY, QTY01=CA) Start: 01/01/1995 | Stop: 10/16/2003 78 Non-Covered days/Room charge adjustment. Start: 01/01/1995 79 Cost Report days. (Handled in MIA15) Start: 01/01/1995 | Stop: 10/16/2003 80 Outlier days. (Handled in QTY, QTY01=OU) Start: 01/01/1995 | Stop: 10/16/2003 81 Discharges. Start: 01/01/1995 | Stop: 10/16/2003 82 PIP days. Start: 01/01/1995 | Stop: 10/16/2003 83 Total visits. Start: 01/01/1995 | Stop: 10/16/2003 84 Capital Adjustment. (Handled in MIA) Start: 01/01/1995 | Stop: 10/16/2003 85 Patient Interest Adjustment (Use Only Group code PR) Start: 01/01/1995 | Last Modified: 07/09/2007 Notes: Only use when the payment of interest is the responsibility of the patient. 86 Statutory Adjustment. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Duplicative of code 45. 87 Transfer amount. Start: 01/01/1995 | Last Modified: 09/20/2009 | Stop: 01/01/2012 88 Adjustment amount represents collection against receivable created in prior overpayment. Start: 01/01/1995 | Stop: 06/30/2007 89 Professional fees removed from charges. Start: 01/01/1995 90 Ingredient cost adjustment. This change to be effective 04/01/2010: Ingredient cost adjustment. Note: To be used for pharmaceuticals only. Start: 01/01/1995 | Last Modified: 07/01/2009 91 Dispensing fee adjustment. Start: 01/01/1995 92 Claim Paid in full. Start: 01/01/1995 | Stop: 10/16/2003 93 No Claim level Adjustments. Start: 01/01/1995 | Stop: 10/16/2003 Notes: As of 004010, CAS at the claim level is optional. 94 Processed in Excess of charges. Start: 01/01/1995 95 Plan procedures not followed. Start: 01/01/1995 | Last Modified: 09/30/2007 96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. This change to be effective 7/1/2010: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 98 The hospital must file the Medicare claim for this inpatient non-physician service. Start: 01/01/1995 | Stop: 10/16/2003 99 Medicare Secondary Payer Adjustment Amount. Start: 01/01/1995 | Stop: 10/16/2003 100 Payment made to patient/insured/responsible party/employer. Start: 01/01/1995 | Last Modified: 01/27/2008 101 Predetermination: anticipated payment upon completion of services or claim adjudication. Start: 01/01/1995 | Last Modified: 02/28/1999 102 Major Medical Adjustment. Start: 01/01/1995 103 Provider promotional discount (e.g., Senior citizen discount). Start: 01/01/1995 | Last Modified: 06/30/2001 104 Managed care withholding. Start: 01/01/1995 105 Tax withholding. Start: 01/01/1995 106 Patient payment option/election not in effect. Start: 01/01/1995 107 The related or qualifying claim/service was not identified on this claim. This change to be effective 7/1/2010: The related or qualifying claim/service was not identified on this claim. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 108 Rent/purchase guidelines were not met. This change to be effective 7/1/2010: Rent/purchase guidelines were not met. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. Start: 01/01/1995 110 Billing date predates service date. Start: 01/01/1995 111 Not covered unless the provider accepts assignment. Start: 01/01/1995 112 Service not furnished directly to the patient and/or not documented. Start: 01/01/1995 | Last Modified: 09/30/2007 113 Payment denied because service/procedure was provided outside the United States or as a result of war. Start: 01/01/1995 | Last Modified: 02/28/2001 | Stop: 06/30/2007 Notes: Use Codes 157, 158 or 159. 114 Procedure/product not approved by the Food and Drug Administration. Start: 01/01/1995 115 Procedure postponed, canceled, or delayed. Start: 01/01/1995 | Last Modified: 09/30/2007 116 The advance indemnification notice signed by the patient did not comply with requirements. Start: 01/01/1995 | Last Modified: 09/30/2007 117 Transportation is only covered to the closest facility that can provide the necessary care. Start: 01/01/1995 | Last Modified: 09/30/2007 118 ESRD network support adjustment. Start: 01/01/1995 | Last Modified: 09/30/2007 119 Benefit maximum for this time period or occurrence has been reached. Start: 01/01/1995 | Last Modified: 02/29/2004 120 Patient is covered by a managed care plan. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 24. 121 Indemnification adjustment - compensation for outstanding member responsibility. Start: 01/01/1995 | Last Modified: 09/30/2007 122 Psychiatric reduction. Start: 01/01/1995 123 Payer refund due to overpayment. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Refer to implementation guide for proper handling of reversals. 124 Payer refund amount - not our patient. Start: 01/01/1995 | Last Modified: 06/30/1999 | Stop: 06/30/2007 Notes: Refer to implementation guide for proper handling of reversals. 125 Submission/billing error(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Submission/billing error(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 01/01/1995 | Last Modified: 09/20/2009 126 Deductible -- Major Medical Start: 02/28/1997 | Last Modified: 09/30/2007 | Stop: 04/01/2008 Notes: Use Group Code PR and code 1. 127 Coinsurance -- Major Medical Start: 02/28/1997 | Last Modified: 09/30/2007 | Stop: 04/01/2008 Notes: Use Group Code PR and code 2. 128 Newborn's services are covered in the mother's Allowance. Start: 02/28/1997 129 Prior processing information appears incorrect. Start: 02/28/1997 | Last Modified: 09/30/2007 130 Claim submission fee. Start: 02/28/1997 | Last Modified: 06/30/2001 131 Claim specific negotiated discount. Start: 02/28/1997 132 Prearranged demonstration project adjustment. Start: 02/28/1997 133 The disposition of this claim/service is pending further review. Start: 02/28/1997 | Last Modified: 10/31/1999 134 Technical fees removed from charges. Start: 10/31/1998 135 Interim bills cannot be processed. Start: 10/31/1998 | Last Modified: 09/30/2007 136 Failure to follow prior payer's coverage rules. (Use Group Code OA). Start: 10/31/1998 | Last Modified: 09/30/2007 137 Regulatory Surcharges, Assessments, Allowances or Health Related Taxes. Start: 02/28/1999 | Last Modified: 09/30/2007 138 Appeal procedures not followed or time limits not met. Start: 06/30/1999 | Last Modified: 09/30/2007 139 Contracted funding agreement - Subscriber is employed by the provider of services. Start: 06/30/1999 140 Patient/Insured health identification number and name do not match. Start: 06/30/1999 141 Claim spans eligible and ineligible periods of coverage. Start: 06/30/1999 | Last Modified: 09/30/2007 142 Monthly Medicaid patient liability amount. Start: 06/30/2000 | Last Modified: 09/30/2007 143 Portion of payment deferred. Start: 02/28/2001 144 Incentive adjustment, e.g. preferred product/service. Start: 06/30/2001 145 Premium payment withholding Start: 06/30/2002 | Last Modified: 09/30/2007 | Stop: 04/01/2008 Notes: Use Group Code CO and code 45. 146 Diagnosis was invalid for the date(s) of service reported. Start: 06/30/2002 | Last Modified: 09/30/2007 147 Provider contracted/negotiated rate expired or not on file. Start: 06/30/2002 148 Information from another provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Information from another provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 06/30/2002 | Last Modified: 09/20/2009 149 Lifetime benefit maximum has been reached for this service/benefit category. Start: 10/31/2002 150 Payer deems the information submitted does not support this level of service. Start: 10/31/2002 | Last Modified: 09/30/2007 151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. Start: 10/31/2002 | Last Modified: 01/27/2008 152 Payer deems the information submitted does not support this length of service. This change to be effective 7/1/2010: Payer deems the information submitted does not support this length of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 10/31/2002 | Last Modified: 09/20/2009 153 Payer deems the information submitted does not support this dosage. Start: 10/31/2002 | Last Modified: 09/30/2007 154 Payer deems the information submitted does not support this day's supply. Start: 10/31/2002 | Last Modified: 09/30/2007 155 Patient refused the service/procedure. Start: 06/30/2003 | Last Modified: 09/30/2007 156 Flexible spending account payments. Note: Use code 187. Start: 09/30/2003 | Last Modified: 01/25/2009 | Stop: 10/01/2009 157 Service/procedure was provided as a result of an act of war. Start: 09/30/2003 | Last Modified: 09/30/2007 158 Service/procedure was provided outside of the United States. Start: 09/30/2003 | Last Modified: 09/30/2007 159 Service/procedure was provided as a result of terrorism. Start: 09/30/2003 | Last Modified: 09/30/2007 160 Injury/illness was the result of an activity that is a benefit exclusion. Start: 09/30/2003 | Last Modified: 09/30/2007 161 Provider performance bonus Start: 02/29/2004 162 State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. Start: 02/29/2004 163 Attachment referenced on the claim was not received. Start: 06/30/2004 | Last Modified: 09/30/2007 164 Attachment referenced on the claim was not received in a timely fashion. Start: 06/30/2004 | Last Modified: 09/30/2007 165 Referral absent or exceeded. Start: 10/31/2004 | Last Modified: 09/30/2007 166 These services were submitted after this payers responsibility for processing claims under this plan ended. Start: 02/28/2005 167 This (these) diagnosis(es) is (are) not covered. This change to be effective 7/1/2010: This (these) diagnosis(es) is (are) not covered. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 168 Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan. Start: 06/30/2005 | Last Modified: 09/30/2007 169 Alternate benefit has been provided. Start: 06/30/2005 | Last Modified: 09/30/2007 170 Payment is denied when performed/billed by this type of provider. This change to be effective 7/1/2010: Payment is denied when performed/billed by this type of provider. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 171 Payment is denied when performed/billed by this type of provider in this type of facility. This change to be effective 7/1/2010: Payment is denied when performed/billed by this type of provider in this type of facility. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 172 Payment is adjusted when performed/billed by a provider of this specialty. This change to be effective 7/1/2010: Payment is adjusted when performed/billed by a provider of this specialty. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 173 Service was not prescribed by a physician. Start: 06/30/2005 | Last Modified: 09/30/2007 174 Service was not prescribed prior to delivery. Start: 06/30/2005 | Last Modified: 09/30/2007 175 Prescription is incomplete. Start: 06/30/2005 | Last Modified: 09/30/2007 176 Prescription is not current. Start: 06/30/2005 | Last Modified: 09/30/2007 177 Patient has not met the required eligibility requirements. Start: 06/30/2005 | Last Modified: 09/30/2007 178 Patient has not met the required spend down requirements. Start: 06/30/2005 | Last Modified: 09/30/2007 179 Patient has not met the required waiting requirements. This change to be effective 7/1/2010: Patient has not met the required waiting requirements. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 180 Patient has not met the required residency requirements. Start: 06/30/2005 | Last Modified: 09/30/2007 181 Procedure code was invalid on the date of service. Start: 06/30/2005 | Last Modified: 09/30/2007 182 Procedure modifier was invalid on the date of service. Start: 06/30/2005 | Last Modified: 09/30/2007 183 The referring provider is not eligible to refer the service billed. This change to be effective 7/1/2010: The referring provider is not eligible to refer the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 184 The prescribing/ordering provider is not eligible to prescribe/order the service billed. This change to be effective 7/1/2010: The prescribing/ordering provider is not eligible to prescribe/order the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 185 The rendering provider is not eligible to perform the service billed. This change to be effective 7/1/2010: The rendering provider is not eligible to perform the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 186 Level of care change adjustment. Start: 06/30/2005 | Last Modified: 09/30/2007 187 Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.) Start: 06/30/2005 | Last Modified: 01/25/2009 188 This product/procedure is only covered when used according to FDA recommendations. Start: 06/30/2005 189 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service Start: 06/30/2005 190 Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay. Start: 10/31/2005 191 Not a work related injury/illness and thus not the liability of the workers' compensation carrier. Start: 10/31/2005 | Last Modified: 09/30/2007 192 Non standard adjustment code from paper remittance. Note: This code is to be used by providers/payers providing Coordination of Benefits information to another payer in the 837 transaction only. This code is only used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment. Start: 10/31/2005 | Last Modified: 09/30/2007 193 Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly. Start: 02/28/2006 | Last Modified: 01/27/2008 194 Anesthesia performed by the operating physician, the assistant surgeon or the attending physician. Start: 02/28/2006 | Last Modified: 09/30/2007 195 Refund issued to an erroneous priority payer for this claim/service. Start: 02/28/2006 | Last Modified: 09/30/2007 196 Claim/service denied based on prior payer's coverage determination. Start: 06/30/2006 | Stop: 02/01/2007 Notes: Use code 136. 197 Precertification/authorization/notification absent. Start: 10/31/2006 | Last Modified: 09/30/2007 198 Precertification/authorization exceeded. Start: 10/31/2006 | Last Modified: 09/30/2007 199 Revenue code and Procedure code do not match. Start: 10/31/2006 200 Expenses incurred during lapse in coverage Start: 10/31/2006 201 Workers Compensation case settled. Patient is responsible for amount of this claim/service through WC 'Medicare set aside arrangement' or other agreement. (Use group code PR). Start: 10/31/2006 202 Non-covered personal comfort or convenience services. Start: 02/28/2007 | Last Modified: 09/30/2007 203 Discontinued or reduced service. Start: 02/28/2007 | Last Modified: 09/30/2007 204 This service/equipment/drug is not covered under the patient's current benefit plan Start: 02/28/2007 205 Pharmacy discount card processing fee Start: 07/09/2007 206 National Provider Identifier - missing. Start: 07/09/2007 | Last Modified: 09/30/2007 207 National Provider identifier - Invalid format Start: 07/09/2007 | Last Modified: 06/01/2008 208 National Provider Identifier - Not matched. Start: 07/09/2007 | Last Modified: 09/30/2007 209 Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use Group code OA) Start: 07/09/2007 210 Payment adjusted because pre-certification/authorization not received in a timely fashion Start: 07/09/2007 211 National Drug Codes (NDC) not eligible for rebate, are not covered. Start: 07/09/2007 212 Administrative surcharges are not covered Start: 11/05/2007 213 Non-compliance with the physician self referral prohibition legislation or payer policy. Start: 01/27/2008 214 Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment. (Note: To be used for Workers' Compensation only) Start: 01/27/2008 215 Based on subrogation of a third party settlement Start: 01/27/2008 216 Based on the findings of a review organization Start: 01/27/2008 217 Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. (Note: To be used for Workers' Compensation only) Start: 01/27/2008 218 Based on entitlement to benefits (Note: To be used for Workers' Compensation only) Start: 01/27/2008 219 Based on extent of injury (Note: To be used for Workers' Compensation only) Start: 01/27/2008 220 The applicable fee schedule does not contain the billed code. Please resubmit a bill with the appropriate fee schedule code(s) that best describe the service(s) provided and supporting documentation if required. (Note: To be used for Workers' Compensation only) Start: 01/27/2008 221 Workers' Compensation claim is under investigation. (Note: To be used for Workers' Compensation only. Claim pending final resolution) Start: 01/27/2008 222 Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. This change to be effective 7/1/2010: Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/01/2008 | Last Modified: 09/20/2009 223 Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created. Start: 06/01/2008 224 Patient identification compromised by identity theft. Identity verification required for processing this and future claims. Start: 06/01/2008 225 Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837) Start: 06/01/2008 226 Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 09/21/2008 | Last Modified: 09/20/2009 227 Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 09/21/2008 | Last Modified: 09/20/2009 228 Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer for their adjudication Start: 09/21/2008 229 Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Note: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. Use Group Code PR. Start: 01/25/2009 230 No available or correlating CPT/HCPCS code to describe this service. Note: Used only by Property and Casualty. Start: 01/25/2009 231 Mutually exclusive procedures cannot be done in the same day/setting. This change to be effective 7/1/2010: Mutually exclusive procedures cannot be done in the same day/setting. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 07/01/2009 | Last Modified: 09/20/2009 232 Institutional Transfer Amount. Note - Applies to institutional claims only and explains the DRG amount difference when the patient care crosses multiple institutions. Start: 11/01/2009 A0 Patient refund amount. Start: 01/01/1995 A1 Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 01/01/1995 | Last Modified: 09/20/2009 A2 Contractual adjustment. Start: 01/01/1995 | Last Modified: 02/28/2007 | Stop: 01/01/2008 Notes: Use Code 45 with Group Code 'CO' or use another appropriate specific adjustment code. A3 Medicare Secondary Payer liability met. Start: 01/01/1995 | Stop: 10/16/2003 A4 Medicare Claim PPS Capital Day Outlier Amount. Start: 01/01/1995 | Last Modified: 09/30/2007 | Stop: 04/01/2008 A5 Medicare Claim PPS Capital Cost Outlier Amount. Start: 01/01/1995 A6 Prior hospitalization or 30 day transfer requirement not met. Start: 01/01/1995 A7 Presumptive Payment Adjustment Start: 01/01/1995 A8 Ungroupable DRG. Start: 01/01/1995 | Last Modified: 09/30/2007 B1 Non-covered visits. Start: 01/01/1995 B2 Covered visits. Start: 01/01/1995 | Stop: 10/16/2003 B3 Covered charges. Start: 01/01/1995 | Stop: 10/16/2003 B4 Late filing penalty. Start: 01/01/1995 B5 Coverage/program guidelines were not met or were exceeded. Start: 01/01/1995 | Last Modified: 09/30/2007 B6 This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty. Start: 01/01/1995 | Stop: 02/01/2006 B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service. This change to be effective 7/1/2010: This provider was not certified/eligible to be paid for this procedure/service on this date of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 B8 Alternative services were available, and should have been utilized. This change to be effective 7/1/2010: Alternative services were available, and should have been utilized. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 B9 Patient is enrolled in a Hospice. Start: 01/01/1995 | Last Modified: 09/30/2007 B10 Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test. Start: 01/01/1995 B11 The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor. Start: 01/01/1995 B12 Services not documented in patients' medical records. Start: 01/01/1995 B13 Previously paid. Payment for this claim/service may have been provided in a previous payment. Start: 01/01/1995 B14 Only one visit or consultation per physician per day is covered. Start: 01/01/1995 | Last Modified: 09/30/2007 B15 This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. This change to be effective 7/1/2010: This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 B16 'New Patient' qualifications were not met. Start: 01/01/1995 | Last Modified: 09/30/2007 B17 Payment adjusted because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription is not current. Start: 01/01/1995 | Stop: 02/01/2006 B18 This procedure code and modifier were invalid on the date of service. Start: 01/01/1995 | Last Modified: 09/21/2008 | Stop: 03/01/2009 B19 Claim/service adjusted because of the finding of a Review Organization. Start: 01/01/1995 | Stop: 10/16/2003 B20 Procedure/service was partially or fully furnished by another provider. Start: 01/01/1995 | Last Modified: 09/30/2007 B21 The charges were reduced because the service/care was partially furnished by another physician. Start: 01/01/1995 | Stop: 10/16/2003 B22 This payment is adjusted based on the diagnosis. Start: 01/01/1995 | Last Modified: 02/28/2001 B23 Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test. Start: 01/01/1995 | Last Modified: 09/30/2007 D1 Claim/service denied. Level of subluxation is missing or inadequate. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D2 Claim lacks the name, strength, or dosage of the drug furnished. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D3 Claim/service denied because information to indicate if the patient owns the equipment that requires the part or supply was missing. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D4 Claim/service does not indicate the period of time for which this will be needed. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D5 Claim/service denied. Claim lacks individual lab codes included in the test. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D6 Claim/service denied. Claim did not include patient's medical record for the service. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D7 Claim/service denied. Claim lacks date of patient's most recent physician visit. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D8 Claim/service denied. Claim lacks indicator that 'x-ray is available for review.' Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D9 Claim/service denied. Claim lacks invoice or statement certifying the actual cost of the lens, less discounts or the type of intraocular lens used. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D10 Claim/service denied. Completed physician financial relationship form not on file. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 17. D11 Claim lacks completed pacemaker registration form. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 17. D12 Claim/service denied. Claim does not identify who performed the purchased diagnostic test or the amount you were charged for the test. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 17. D13 Claim/service denied. Performed by a facility/supplier in which the ordering/referring physician has a financial interest. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 17. D14 Claim lacks indication that plan of treatment is on file. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 17. D15 Claim lacks indication that service was supervised or evaluated by a physician. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 17. D16 Claim lacks prior payer payment information. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code [N4]. D17 Claim/Service has invalid non-covered days. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code. D18 Claim/Service has missing diagnosis information. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code. D19 Claim/Service lacks Physician/Operative or other supporting documentation Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code. D20 Claim/Service missing service/product information. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code. D21 This (these) diagnosis(es) is (are) missing or are invalid Start: 01/01/1995 | Stop: 06/30/2007 D22 Reimbursement was adjusted for the reasons to be provided in separate correspondence. (Note: To be used for Workers' Compensation only) - Temporary code to be added for timeframe only until 01/01/2009. Another code to be established and/or for 06/2008 meeting for a revised code to replace or strategy to use another existing code Start: 01/27/2008 | Stop: 01/01/2009 D23 This dual eligible patient is covered by Medicare Part D per Medicare Retro-Eligibility. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 11/01/2009 | Stop: 01/01/2012 W1 Workers Compensation State Fee Schedule Adjustment Start: 02/29/2000

Courtesy of BlueCross BlueShield of Nebraska.

How Mental Health Practitioners Can Get Involved in the Legislative Process

The Association for Private Practice Therapists Fall Conference was held on November 20, 2009. Anne Buettner was one of the panelists. Anne Buettner, MA., is a therapist in private practice in Grand Island. She is the current legislative chair of NAMFT, and immediate past president of Nebraska Association for Marriage and Family Therapy. Anne had served as president of NAMFT for three terms in three decades. She is a previous member of the mental health practice credentialing board, 1993-2003, and has been actively involved in various legislative processes, including the successful quest for independent mental health practitioner licensure.

By Anne Buettner

To talk about legislative process as a mental health professional, I could be preaching to the choir here. I think most mental health professionals in this room have some legislative experience, be it making that phone call to a senator or providing language for a bill. In short, you all have been instrumental in trying to succeed or succeeding in the passage of a bill.

For the few minutes that I have, it is not so much sharing the knowledge but the sharing of philosophies or attitudes as one single mental health professional who had walked through the passage of the law of Licensed Mental Health Practitioners in 1993 and the passage of the law of Licensed Independent Mental Health Practitioners in 2007.

As therapists, we are change agents. In the legislature, we need to be change agents too. The skills are transferable. The macro impact is law making. You can equate helping clients in your office to change as micro impact. That is our livelihood. But changing or making law is making an impact on our profession and our livelihood.

Look at LIMHP. Yes, it is the “I” that makes the difference. It does not just affect LMHPs. It affects psychologists, psychiatrists, nurses, etc., -- i.e. the entire mental health profession.

At first there were the naysayers, but when the train arrived most of them got on. They said it was a pie in the sky. Building castles in the air. So you say to them, “If we have built castles in the air, our work need not be lost; that is where we should be. Now put the foundations under them.” This is a saying from Henry David Thoreau. So first of all you need to have that belief. And as a matter of fact, the belief needs to be a passion.

You need to have a core group that shares the passion. Not everyone needs to have the passion. But the core group, no matter how small, needs passion because the journey is usually long and arduous.

Independence (as therapists) took us four years. Mental Health Practice took us eight years.

Even though clients give you permission to help them to change, you know there is the resistance to change. It is the same with legislators except they have not given us permission to change them. They may give us permission to talk to them. Sen. Mike Gloor, my senator from Grand Island, once quoted a wise man who once said, “Change has many enemies and few friends.” So keep in mind, if their first response is “no,” you should not take it as last response. “No” may mean ‘no’ on that day. 

You have to realize the 49 senators do not become legislators to make changes in credentialing law of mental health practitioners. They have loftier goals. How do you get them to become interested, to listen, to understand ( how do you explain major mental disorder?!), and care to vote? Yes, you need a lobbyist. But a lobbyist will tell you that you need to do grassroots advocacy. You need to find constituents to make the contacts. How do you find a constituent in Louisville or Cortland or Platte Center? You need a large number of constituents and you need a coalition; coalition among the mental health disciplines.

Fifteen years ago I polled some legislators with whom I worked, and I asked them which interests group that they experienced as most feisty and divisive. I expected them to say the business sector. To my chagrin, they said unanimously the mental health professionals have the most amount of fighting among themselves. Fifteen years hence, I do not know where we stand. But for sure there are different view points and different sound bites. We are sometimes painfully as well as respectfully aware of this reality.

I like what Sen. Dubas wrote in this past summer …the art of compromise. You notice that there are three avenues to become independent in the independence law. (One for each of the three disciplines! ) You need to be positive…and realistic. “I am an optimist, but an optimist who carries a raincoat.” (Harold Wilson said that.) The cynics would say that you cannot trust anybody in politics. I would say in politics, there are no friendships, there are alliances. By the same token, there are no friendships, no enemies. Of course, alliances can shift from time to time. Nonetheless, like good attorneys, you can fight in court and you can go out to lunch afterwards. You can be holding hands at one issue, and testifying against each other’s position at another issue.

Compelling stories and statistics help. But most importantly, the message needs to be simple and brief. A one-page fact sheet is all legislators have time to read seriously. I am so used to giving elevator speeches. Always find an angle that engages them. Do not underestimate that contact, be it a phone call and that short note or email, however electronically scripted. Voices for Children reported that

“ the Appropriation Committee and the Governor received thousands of e-mails from Nebraskans indicating what they think are the priorities of the state budget should be. Their voice is making a difference. The Governor proposed budget cuts seemed to recognize the vulnerability of Nebraska’s children and families struggling to make ends meets during these difficult economic times and made few cuts to the social safety net.”

I do not want to leave you with the impression it’s all about who’s making the loudest noise and maneuvering to bend the ears of the legislators. You need 25 senators to pass a bill. In the final analysis, I do see that legislators want to do good for their communities. The fact remains is that there are different options to do it. When we embrace any legislative project, we have to believe that we are doing good not just for the providers such as ourselves, but for the consumers too. Of course, we can be consumers any day too. That common ground… we need to negotiate. The overarching argument is to do good for the consumers.

In the end, in the arena of legislation, just like in any battlefields, “ You’re never as good as everyone tells you when you win, and you’re never as bad as they say when you lose.” 

What IS Brand You?

As I talk about in my e-book, "Therapist's Guide to Branding Yourself Online," as a therapist, you probably already have a brand, you just don't know what it is.

To have a strong brand, you must be clear about who you are and who you are not. A successful brand as a therapist must be authentic -- it must reflect your unique personal attributes or qualities.

To cultivate the brand that will help you reach your goals, you must understand and be able to articulate and communicate what makes you exceptional and compelling.

In talking with many therapists, however, they have a hard time with this!

You may think that by articulating a specific niche area you work with that you will only be able to work with clients with this issue or presenting problem. On the contrary! If you are known as a specialist, you are more likely to get general referrals -- simply because your name is more well known.

If you are interested in learning more about branding yourself and marketing your private practice online, purchase the 20-page e-book.

You'll learn:

• Whether or not you are "digitally distinct" (page 3)
• 11 questions to help you identify what makes you unique as a therapist (page 4)
• Five things you must consider when writing your online profile (page 7)
• Strategies to attract your "ideal" client (page 8)
• Specific tips for writing an online profile (page 11)
• How to turn visitors to your online bio/profile into clients (page 14)
• What one thing can attract 50-70 percent more inquiries to your profile (page 15)
• How to drive prospects to your online presence (page 16)

10 Quickest Ways to Lose Out on Insurance Reimbursement

courtesy of Kim French, Summit-Edge

1.     Not getting on enough insurance panels: The more panels you’re on, the easier it will be to attract clients.

2.     Not getting enough information upfront: Insurance billing is information driven. Make sure you collect all necessary information from the family. Then, verify this information with the insurance company.

3.     Not getting and following the authorization: Always see if an authorization is needed. If it is, make sure you get it documented. Then, stick the authorization letter in your clinical file, and make sure you follow it carefully.

4.     Not billing enough: Billing less than the maximum allowed is throwing money out the window. Use the Blue Cross/Blue Shield allowable rates as a guide in making sure you’re billing enough.

5.     Not billing correctly: Insurance companies are very fussy about the claims. Make sure you’re dotting the “i”s and crossing the “t”s.

6.     Not billing timely: More and more insurance companies are requiring that the billing be completed very quickly -- 60 to 90 days is not unusual. Given the complexity of insurance billing, these new time requirements will be costly for providers. The billing process will need to move very quickly.

7.     Not reviewing the EOBs: The EOBs will tell you whether or not everything is getting paid according to plan. If something goes wrong, the EOB or denial will sound the first alarm.

8.     Not responding to insurance company requests: If the insurance company asks for information from you, or from the family, make sure it gets that information. They won’t ask twice.

9.     Not following up: It is very easy for an insurance company to ignore or deny a claim. So, a powerful follow-up system is essential to keeping the claims in process. If you don’t have it, the insurance companies will wear you down.

10.  Not paying attention to what’s going on: Know what panels you’re on. Know what diagnoses and procedures get scrutinized. Know what the Medicaid procedures are.

Best Practices in Child Sexual Abuse Summer Series 2010

Best Practices in Child Sexual Abuse: Summer Series

A 5-part training program sponsored by Project Harmony, Metropolitan Child Advocacy Coalition, the 1184 Treatment Teams, and the Nebraska Department of Health and Human Services

Part 1: Reporting and Responding to Child Abuse and Neglect 

is free and available July 23 or Oct 26

To register, click on http://www.nebraskacacs.com/TrainingAndEvents

                 

Friday, July 29

Part 2:         Understanding and Assessing Child Sexual Abuse:

(9:00 a.m. - 12:00 p.m.)

Part 3:         Safety Planning in Sexual Abuse Cases:

(1:00-4:00 p.m.)

Friday, August 27

Part 4:        Treatment, Reconciliation, and Reunification:

(9:00 a.m. –12:00 p.m.)

Part 5:        Resources, Supervision, and Professional Development:

The Ethical Practitioner (includes 3 ethics CEUs):

(1:00-4:00 p.m.)

        

Audience:  

Licensed mental health practitioners, social workers, marriage and family therapists, psychologists, and psychiatrists in Nebraska and Iowa.

Cost:  

Part 1 is free; the remaining courses are $30 each.

Referrals:  

In order to receive referrals from Project Harmony Child Protection Center, licensed mental health practitioners will need to complete the entire series in any order.

To download a registration form, click here.

Using Michael Port's Book Yourself Solid 4-Part System

A few months back, I had the opportunity to participate in a call with Michael Port, author of Book Yourself Solid.

I like his 4-Part Sales Formula -- and recommend therapists use these principles in talks with prospective clients.

Question #1: What is your goal? What do you want out of therapy?
- Once you feel certain you know what they want to accomplish (and what their timeframe is), ask:

Question #2: How will you know when you've accomplished your goal? What results will you see? What feelings will you have?
- Once you feel like the prospective client has articulated these outcomes, ask:

Question #3: Would you like someone to help you accomplish this goal?
- If they say "No," wish them the best of luck and keep in touch with them.
- If they say, "Yes," then ask:

Question #4: Would you like that person to be me? Because, you know, you are my ideal client.
- When they say, "What do you mean?" respond with, "Because you are someone with whom I can do my best work, because you are ..." (and then list the qualities that make them who they are.)


For more information, read his book:

Have a Therapy Directory Listing, But No Website?

Do you have a Therapy Directory listing, but no website? 

If you're not ready for a full-fledged website, you can create a simple, one-page website by registering your vanity domain name and pointing it to your Therapy Directory profile.

Want help making this happen? For just $15, I'll register the custom domain name of your choice and redirect it to your Therapy Directory profile. 

To purchase this service, click here.

You can then use the domain name on all of your materials -- letterhead, business card, articles, brochures, and more. And, in the future, if you decide to develop a full website, you can simply point the domain name to the new website.

Here's an example of how this works:

http://www.debshaddy.com