This just started oct 1, 2022 so i'm assuming new fiscal years 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 Claims are being denied for lcd on an office visit with psychiatric dx codes, (these are not dementia or cognitive impairment codes)
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Is anyone else noticing aetna e/m claims being randomly downcoded without any justification
We have had many 99214 downcoded to 99213, even though the mdm supported the 99214
If you are experiencing this and likely appealing, have you had any success in getting these decisions overturned? 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 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. 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
Claim submitted like we usually do
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 It seems to vary by payer and i know some are following medicare guidelines but we are. We have not changed anything in our submission process which is done via a billing vendor who uses the availity clearinghouse
