Modifier to show difference in Speciality

Hello

We are billing for Group Practice but UHC is denying our claims with each other as duplicate. We spoke with CSRs and got claims reprocess by showing them the difference of speciality and diagnosis that we billed on claims but they are still denying with the same reason and they are asking to append modifier to show the difference in speciality.
Can someone please help me what modifier to bill? as per my knowledge there is no modifier that i can bill to show differnce in speciality.

all you help would be highly appriciated.

Thanks

re: Modifier to show difference in Speciality

None that I am aware of.

re: Modifier to show difference in Speciality

You are correct; there is no modifier to differentiate specialty. I have similar issue going on with UHC can you please tell me are your visit same day?

re: Modifier to show difference in Speciality

THnak you very much for your reponse; our visits are on the same day and I have appealed as well but appeal is also denied due to the same reason. Would do you think what is the solution of this problem? what you decieded to do with your claims?

re: Modifier to show difference in Speciality

Are the clinicians enrolled with the correct specialty type?

re: Modifier to show difference in Speciality

yes we discussed with Provider Rep of UHC as well and our credentialing deptt verified this. We are enrolled with the correct speciality type..

re: Modifier to show difference in Speciality

Im not sure if this is your issue with UHC but mine is this: We are an Ortho group and we have a PT enity of our practice which practices under the same tax ID # often times appts are scheduled on the same day and this results in a denial from UHC stating; same day services not allowed. I researched UHC medical payment policy regarding this issue and found the following: UHC defines Same Specialty Physician or other Health Care Professional as: Physicians and/or other health care professionals of the same group and same specialty reporting the same Federal Tax Identification number. Despite being in the same group and sharing a tax ID #, weare not of the same specialty. Per UHC Medical Payment Policy addressing PT, We need to be sure we are distinguishing our claims by specialty and this can be done by appending a modifier. When billing PT services, we bill visit codes of 97001, 97002, 97003 or 97004 we will need to append the GP modifier - Services Delivered Under an Outpatient Physical Therapy Plan of Care—Used on Therapy Services Only when billing Medicare. When billing UHC, they require modifiers GO (Services delivered under an outpatient occupational therapy plan of care) or GP (Services delivered under an outpatient physical therapy plan of care). My suggestion for my practice is to dispute the denials based upon UHC's definition on same day services which we do not meet. I am hoping for a favorable outcome. If this is not your issue, search their payment policies and you may find help for your situation. Best Wishes!

re: Modifier to show difference in Speciality

I appriciate all of your help agent00711 and I will search theri payment policies again.

re: Modifier to show difference in Speciality

Are the doctors using the same diagnosis code?

re: Modifier to show difference in Speciality

no , ecah physician is using different diagnosis code according to his speciality.