Jennifer

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  • First I need to find all claims finalized since the last time we filed.
  • So now I want to eliminate all claims that do not have procedure codes xxxxx , yyyyy, or zzzzz on them since those are the only services covered for MKP.
  • First I need to find all claims finalized since the last time we filed. Okay now I need to exclude all that were denied. I can only submit paid claims.
  • The best way for me to make sure that we have never submitted this service before is to verify it doesn't have modifiers AS or 80. So I can exlcude these 208 claims.
  • I almost forgot. I also cannot submit MKP fee for service claims for any dual eligible members. I can do that by checking their division in eligibility.
  • Okay! I should now have all claims eligibile for MKP FFS submission to the State of XX. We are ready to move to gathering all the data for the actual submission.
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