Coding Tip: Payors “Remap” Codes

It is frustrating to submit a code that is correct and have an insurance company change the code to an alternate benefit. Can they really do that? No, they can’t. What they can do is to “remap” the reimbursement to another code. Remapping defined is that the insurance payor recognizes the submitted code but provides payment based on an alternate benefit. A little know fact: The ADA requests to be notified of any instances when the payor changes the code submitted.  

Dental Billing Tips and News for Pros; Edition #130

1 Comments

  • Alternate benefit payments are getting out of control to the point that ALL the necessary information to estimate insurance for a patient’s appointment is verified in a matter of minutes but it takes 20 minutes on the phone with a representative trained in tricky verbiage to clarify the 57 stipulations necessary for accurate estimation. Is remapping considered the same thing as changing the code by the ADA since the original code is acknowledged in the EOB?

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