I am hoping someone can offer any info. I am having issues with Anthem BC/BS of Ohio denying partial hospitalization charges for professional services though denial and payment is inconsistent – sometimes they pay, sometimes they don’t.

We are billing the professional fees with POS 52 and inpatient E/M codes and have been told verbally by Anthem (nothing provided in writing) that it is correct for us to bill this way. Yet, we still encounter denials stating things such as no inpatient facility claim on file (facility is billed outpatient and supposedly this is correct), no inpatient auth on file (again facility bills outpatient so the auth on file is outpatient), or inappropriate place of service. I am wondering if anyone can shed any light on what they know about billing partial hospitalization for either professional or facility charges especially if you have experience with billing Anthem Ohio. I’ve read online that the facility charges should be billed with an outpatient bill type but I’ve also seen where a condition code of 41 may be required? Since I am unable to get any clear, documented info from my Anthem rep I am hoping that maybe, just maybe you all can shed some light so that maybe I can ask better questions or something :confused: I don’t know but I thank you all in advance for any help you can provide!