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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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