Should I be concerned about this code 35?

Should I be concerned about this claim?

On the RA, it shows $0.00 paid with a code 35,  yet in HYPEMedical it is Paid.

Check out the History (Audit Trail) of this claim on the Claim Details page. In this particular case, the audit shows that the claim was edited three times before it was fully paid, and the last resubmission was an edit after payment was made. That is why the already-paid items were flagged with code 35.

A claim with paid service codes, especially a complex claim, may be edited and resubmitted.

OHIP's software will automatically flag each previously paid service code with rejection code 35.

OHIP's RA communicates with HYPEMedical. The RA in this example shows that OHIP paid $0.00 for a service code and flagged it with rejection code 35. HYPEMedical added $0.00 to the already paid service code. Therefore the totals balance.

 

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