DecisionHealth, DecisionHealth - 2021 Issue 5 (May)

New diagnosis? Try a corrected claim, but expect pushback from your MAC

Question: We’ve had a claim denied on the basis of medical necessity because the provider’s original diagnosis was not covered. Now the provider, after further analysis, has determined that the actual issue is different from what she had originally thought and she wants to change her diagnosis and treatment. Can we resubmit the previous claim with the new diagnosis?

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