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Error JI
Medium UrgencyCritical Care Team Billing Conflict
MSP needs justification for a specialist service provided to a patient in a critical care unit.
Official Description: There is insufficient medical necessity to process this claim. Resubmit explaining the need for services outside the critical care team, if applicable.
How to Fix It
Follow these steps in order to resolve the error.
- Verify the patient's location on the date of service. This rejection code typically means the patient was in a designated critical care unit (e.g., ICU, CCU).
- Confirm with the billing physician that their service was explicitly requested by the critical care team or attending physician in the unit.
- If the service was requested, resubmit the claim with a clear and concise note record. The note must explain the medical necessity. For example: 'Service requested by Dr. [Name of requesting physician] for specialist assessment of [specific condition].'
- If the service was not specifically requested by the critical care team, the fee is likely not payable by MSP as it is considered part of the global critical care fee. Discuss with the physician before resubmitting.
- If you have confirmed medical necessity and added a note but the claim is rejected again, contact Teleplan Client Services at 604-683-7151 to review the claim with an adjudicator.