Question

During processing of the encounter form (to generate the claim), the insurance specialist notices that the provider entered a check mark in front of the procedure, "Blood, occult (feces)," and a check mark in front of the diagnosis, "Hypertension." Because medical necessity requires the diagnosis selected to justify the procedure performed, what should the insurance specialist do next?

Answer 1

Answer:

The diagnosis   is a total misnomer.There was no correlation  between the  diagnosis  codes and the procedure carried out.Therefore the issuance officer needs further clarification from the health provider  in charge to verify the accuracy of the codes for  possible error  to avoid  misinformation.

Explanation: