Request a Blog: ADF Error Code

ADF error codeIt’s back to school time, and we’ve returned with more lessons on error codes. Our most recent request a blog querent wanted to know how to deal with the ADF error code.

ADF Error Code – corresponding procedure rejected

A recent addition to the legions of OHIP error codes, ADF was introduced in February 2015 to deal with cases (such as special visits) where a code that depends on another, primary billing code, is rejected. The Ministry of Health describes ADH as “Corresponding Procedure Invalid, Omitted or Paid at zero”. What does that mean in practice? Let’s look at an example.

A615 – A36 or rejected for another reason
K998 – ADF
K963 – ADF

Billing a hematology consultation with weekend special visit & travel premiums is a common situation. If the special visit codes come back ADF, that indicates that there’s a problem with the primary code, A615. In the example, A615 has been rejected as paid to another doctor, though that’s just one possible reason. Because the consultation has been deemed invalid, the special visits K998 & K963 won’t be paid either, as they’re add on’s to A615. Any codes that are add on’s to a primary billing code won’t be paid unless the main code is approved.

Similarily, if K998 or any other special visit is billed alone it will be rejected ADF on an error report, or DF on the remittance advice summary. Special visits and many other premiums and add on’s can’t be submitted without a visit, consultation, or primary procedure code on the same date of service.

DF – a close cousin
DF means the same thing as ADF: DF states that the code rejected is not allowed alone, so the corresponding code has either not been billed… or not been paid. Remittance advice explanatory codes are 2 characters long, while error codes are 3 characters. The difference between the two  is that ADF on an error report allows you to correct and resubmit the claim, while DF indicates the MOH’s payment decision on that claim. Changes to remittance advice payments require that an RA inquiry form be sent to your claims assessor.

 

What to do?

A bit of detective work is needed. If your primary billing code was sent in with the premium, you’ll need to find out why it was rejected. Consult the error report, and if there’s no error code, you can call your claims assessor to find out what happened to the main code. If there’s an unresolvable conflict with a consultation code, you could consider submitted a lesser assessment code with the special visit.

Should the primary billing code be missing, find out what kind of code you premium should be billed with by searching the Schedule of Benefits, both the general preamble and the specialty listings. Match the code – usually a consultation or assessment – to the service provided and resubmit the complete claim with special visits. MOH willing, it should get paid on the next RA.

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