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Coventry Health Care Is Performing Across The Board Audits Of All Physician Claims Meeting Specified

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2013-12-18 08:19:21 - As a medical billing company, we have the benefit of seeing and identifying insurance trends because of our mass involvement in various states and provider specialties.

When any of our clients claims are denied, we immediately review and/or research the denial to determine our next step in establishing payment for each denied claim. One of the benefits of having us as your medical billing company, is that we are researching claims for multiple providers of multiple specialties from multiple states across the U.S. Health InsuranceOne item that we recently noticed and have confirmed with our insider sources is that Coventry Health Care, which was recently acquired by Aetna early this year, is now performing medical record audits on any claim submitted with a -59 modifier. Coventry Health Care provides health care insurance plans to millions of members in 27 states primarily in the Midwest, Mid-Atlantic, and


A mandatory claim based triggered audit is going to make a large impact on millions of claims.The -59 modifier is defined as "Distinct Procedural Service", and is often confused as having the meaning of "Different Procedure or Surgery" which would be incorrect. If your office is arbitrarily assigning -59 modifiers to your claims, you will be at risk for a negative review and possible provider contract penalties. Also, if you are improperly assigning a -59 modifier to your claim when not even needed, then you are going to impact your cash flow because all lines billed on your claim will not be considered until medical records are properly sent in and reviewed by Coventry Health Care.

As a medical billing company, we believe that this is just the start of mandatory audits in attempts to reduce the outgoing health care costs paid out by insurance plans. It will be imperative that you are properly aligned with a knowledgeable medical billing company that can look out for these pitfalls and keep you informed as well as properly communicating coding education to your office to keep your claims from being targeted and allow uninterrupted processing.

If you are concerned about your practice being able to keep up with insurance regulations and coding and billing principals, please feel free to e-mail us at to hear how we can help by partnering with your practice to provide a solution to your financial needs. Do not wait! Email or call us today at (888) 810-0098 so that you can see how we can benefit you and your practice.

Medical Billing Solutions, Inc. will continue to report on pertinent insurance information in an effort to keep medical providers informed and ahead of the game. Please continue to review our MBS Newsletters carefully so your practice can remain up to date on the most current information available.

Call us today at (888) 810-0098 or visit to learn more about how our medical billing company can help your practice have a better and brighter future.

Contact Information:
Medical Billing Solutions, Inc.

503 Buckeye Dr
Ste 100
Troy, IL

Contact Person:

Phone: (888) 810 - 0098
email: email


Chris Readenour
Phone: 3144230189

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