As paid vs. as it should have been
| Ln | Code | Description | Paid | Should be | Variance | Result |
|---|---|---|---|---|---|---|
| 1 | 85025 |
Blood count, complete, automated, with automated differential
D64.9 · Anemia, unspecified
|
$7.77 | $7.77 | — | Correct |
Determination
Reviewed with no variance. Every line was paid at the allowable on file.
How it was coded
Remedy: None — the claim was billed and priced as the record supports
Reviewed for level, severity and unit count. Nothing billed above what the record carries.
Prior authorization
No prior authorization requirement for this service on this plan.
Policy applied
Knowledge CenterComponent and panel billing for the tests on this claim
No source document for v5.0 is in the index, so this policy can be cited here but not quoted. Upload it.
Coverage on the date of service
v6.1 was extracted from CPP-080_eligibility-enrolment-retroactive-termination_v6.1.md. Passages are quoted only on the policy the finding rests on.