Infinity Psychological Services P.C. v. Liberty Mutual Fire Insurance Co. (7/20/2010)
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The insurance carrier did not deny medical necessity, but refused to cover the claim on the grounds that the provider billed under a nonexistent CPT code. The applicant seeks reimbursment of the sum due had the proper code been used. The arbitrator held that Respondent should have re-coded the claim to reflect the proper code and reimbursed Applicant the correct amount. If there were any doubts as to what was being claimed. Respondent should have requested additional verification. Instead it elected to deny the claim outright due to this clerical error listing the wrong CPT code. This is not a sufficient basis for denying Applicant’s otherwise valid claim.


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