When claims are submitted with diagnosis codes indicating an injury, your insurance carrier will request additional information to clarify how the injury occurred and to determine if any third-party liability is involved, such as automobile or homeowner's insurance.
Even if the injury was not due to an accident or did not involve a third party, you are still required to provide this information. Failure to supply the requested details will result in your claims remaining in denial status, and the provider will continue to bill you for these services. Providing the necessary information is crucial to ensure your claims are reconsidered and processed correctly.
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