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ESD – APP group affiliation on service date

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Background:

This rejection means that the date the service was billed should have been under a billing group. In some cases, if you are registered as a General Practitioner, and you have billed K-Prefix special visit premiums, it is likely because GP’s are not registered for ER billings, which is when K-prefix premiums would typically be billed.

Solution:

If you are registered with a group on the date of service, you will need to change the “group” in the claim to the applicable billing group and submit the claim.

Alternatively, if you have billed K-prefix special visit premiums in the claim, amend the codes to the corresponding C-prefix codes and submit the claim.

 

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