Some of the UHC Medicare Advantage Replacement Plans are denying J7321 for NDC. J7321 does not have an NDC. My sources state it is regulated as a device. What should I do?
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Tag Archives: denying
Affinity Denying CPT Code 10040 – Acne Surgery
I have some claims that Affinity Medicaid has denied for the 10040 (Acne surgery) because the dx code L70.0 (Acne Vulgaris), is saying is not correct or incomplete. Has anybody else received this denial? L70.0 has always been paid with the acne surgery. There is no clinical policy on their website. I asked the rep and they told me to speak to the biller, however I am the biller. There are about 3-4 claims outstanding since Feb 2018. I’m thinking to appeal it with medical records.
Thanks,
Viviana
Aetna denying problem visits as part of global ob
We are having a problem with Idaho Aetna denying OB problem office visits as part of the global ob care, when clearly they are not. ie: URI, Headaches, skin rash, etc. Even after going through their "reconsideration" request (first level of appeal), with supporting documentation including CPT definition of ob global care and proof that we can charge separate office visits for unrelated problems, they are still denying it. It’s like they aren’t even reading my letters! We only get 2 appeals with Aetna, and this is a huge amount of money we are loosing. Now, they have started going back through visits they have already paid on, and taking their money back. I’ve audited all of these visits and they truly are reimbursable services.
I am at my wits end. Does anyone have any suggestions? Does anyone have this problem as well? We don’t have a provider relation rep assigned to us so I can’t complain to them, but seriously, Aetna can’t be withholding payments on billable services like this! HELP!
Medicare denying podiatry E/M codes for home visits
Has anyone been successful in getting paid for podiatry home visits? I keep getting a denial stating that the E/ M code was not reasonable or necessary. The provider’s documentation states the reason for the home visit and why the E/M code is necessary. I’m just curious if anyone else is having the same denials I am?
Medicare denying 2018 radiology replacement codes
Our group is seeing a huge denial trend for the new radiology codes. Specifically 71045, 71046, 74019 with denial *TREATMENT NOT COVERED IN THIS SETTING/POS – 244. The place of services denying are 19 and 23.
I am getting nowhere with Medicare. I was advised to fax a general inquiry form for additional information.
Anyone else having the same issue, any advise?
Thank you!
Medicare denying podiatry E/M codes for home visits
Has anyone been successful in getting paid for podiatry home visits? I keep getting a denial stating that the E/ M code was not reasonable or necessary. The provider’s documentation states the reason for the home visit and why the E/M code is necessary. I’m just curious if anyone else is having the same denials I am?
BCBS denying E/M codes with 25 modifier
I do billing for five different practices across Texas and am having an issue with BCBS. They are denying most E/M codes when we use the 25-modifier (to distinguish from other services rendered the same day). I’ve gotten dozens of these so far. I have read some info online from different practices that BCBS is going to reduce reimbursement on E/M’s when billed with the 25-modifier to 50% of the allowed amount. But I haven’t seen anything in black and white from BCBS itself. Does anyone have any hard information on this change? The dozens of appeals are KILLING me. Maybe I shouldn’t have taken on five practices:eek:.
Denying J Code, but pay for administration?
Sorry I’m not sure how to delete. I just found my answer.
Noridian Denying G0008/90686
Hello,
I’ve recently took over billing for a Internal Med doctor, and I’ve been noticing that my MAC (Noridian-Hawaii) has been denying G0008 & 90686. The EOB states to visit their website on the policy, but of course it takes me every which direction, so I’m just confused and lost. Is it because I have multiple patients on the same DOS that are having these particular services done and I’m not submitting a "roster bill form" with it?
I’ve recently took over billing for a Internal Med doctor, and I’ve been noticing that my MAC (Noridian-Hawaii) has been denying G0008 & 90686. The EOB states to visit their website on the policy, but of course it takes me every which direction, so I’m just confused and lost. Is it because I have multiple patients on the same DOS that are having these particular services done and I’m not submitting a "roster bill form" with it?
Any help/advice would be much appreciated!! Thank you! 
Emedny, n.y. Medicaid denying second line items.
Does anyone else have a problem billing medicaid where it gets denied as below.
99213-25 (Paid)
17110 (denied as bundled)
But if billed as below:
17110 (Paid)
99213-25 (denied as bundled)
They’re apparently ignoring modifier 25s now and only paying the first line item… Medicaid didn’t really tell me why and to look at the medicaid up date new/bulletin of some sort that I have not found to exist.