Fulcrum Health revised the claims processing system on medical necessity edits for CMT. The system edits did not apply as intended and are currently being reviewed by Fulcrum. We apologize for any inconvenience this may have caused.
Claims that were incorrectly denied during the time period of 01/01/2022 – 02/08/2022 due to “Diagnosis Inconsistent with Procedure”, will be reprocessed. We estimate this review and reprocessing effort will be completed by the end of April 2022.
If you have questions on a specific claim, please contact Fulcrum Provider Services at (877) 886-4941, and select option 1, and then listen to the prompts for your specific claim type.