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Is anyone else noticing aetna e/m claims being randomly downcoded without any justification It seems to vary by payer and i know some are following medicare guidelines but we are. We have had many 99214 downcoded to 99213, even though the mdm supported the 99214
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If you are experiencing this and likely appealing, have you had any success in getting these decisions overturned? I am very confused why all of a sudden we are seeing denials using place of service 11 with modifier 95 and now they want us to use pos 10 for telehealth in patient's home and pos 02 if they are not home Has anyone had denials for lcd on a office visit for 99213 from aetna medicare
This just started oct 1, 2022 so i'm assuming new fiscal years
Claims are being denied for lcd on an office visit with psychiatric dx codes, (these are not dementia or cognitive impairment codes) I access our anthem (our local bcbs) fee schedule in availity through claims & payments > fee scheduling listing > additional fee schedules and it's listed there Alternatively, i can go to payer spaces > anthem ohio and fee schedule is one of the options under applications. I would like to know how to properly report codes for 90471 for immunization
Patient went to outpatient office because of chest pain It is then confirmed by the doctor that the chest pain is a contusion front wall of thorax Patient was given ibuprofen oral for the pain Claim submitted like we usually do
We have not changed anything in our submission process which is done via a billing vendor who uses the availity clearinghouse
Somewhere in this process the claims are not being routed to the correct payer id, 54704, and are instead going out with a header of isa08 So every single claim is being rejected as being sent to the wrong payer. On aug 19, 2022 axsome therapeutics announced the fda approval of auvelity, as the first and only oral nmda receptor antagonist for the treatment of major depressive disorder in adults I am so confused on what this arc means
This was sent back to me by blue care network (part of bcbs of mi).i billed a tcm (99496) and medication reconciliation (1111f) The claim was processed without payment due the following The related or qualifying claim/service was not.
