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Wisconsin MedicaidClaims1Family Planning Only ServicesPublished Policy Through July 31, 2020Page 1 of 95Wisconsin MedicaidArchive Date:08/03/2020Claims:Good Faith Claims Topic #518Definition of Good

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How to fill out medically unlikely detail edits

01

Gather all necessary documentation, such as medical records and encounter notes.

02

Review the medically unlikely detail (MUE) edit guidelines to understand the criteria for filling out edits.

03

Identify the specific codes that were denied due to MUE edits.

04

Correctly justify the medical necessity for the codes in question.

05

Include any additional supporting documentation if needed.

06

Submit the corrected claim with the necessary information to the insurance company for review.

Who needs medically unlikely detail edits?

01

Healthcare providers

02

Medical coders

03

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Insurance companies

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What is medically unlikely detail edits?

Medically unlikely edit details are edits that are determined to be unlikely to occur in a medical record based on clinical guidelines and coding rules.

Who is required to file medically unlikely detail edits?

Healthcare providers and coders are required to file medically unlikely detail edits.

How to fill out medically unlikely detail edits?

Medically unlikely detail edits should be filled out by reviewing the medical record and coding guidelines to ensure accurate reporting.

What is the purpose of medically unlikely detail edits?

The purpose of medically unlikely detail edits is to ensure accurate and appropriate coding in medical records for billing and reimbursement purposes.

What information must be reported on medically unlikely detail edits?

The information reported on medically unlikely detail edits includes the specific details of the edit and the rationale for why it is considered medically unlikely.

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