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    Wiki Trauma Billing G0390

    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm5438.pdf
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    Wiki No authorization for Physician Services while Patient was Inpatient

    What state are you in? I billed trauma for 4 years UHC was a nightmare. Emergent services do not require authorization. If it’s UHC Community Plan, then they were and probably still are awful! I had to file hundreds of State Fair Hearings citing Arizona laws (Arizona Revised Statutes and...
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    Wiki BCBS Local Plan Question

    What are the two states? Anthem/BCBS/Any variation of those two should all follow the same guidelines for ancillary claims. Independent Clinical Laboratory (LAB)- File the claim to the Plan in the service area where the specimen was drawn. If the referring provider is not located in the...
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    Wiki Service Location and NPI

    Facilities NPI
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    Wiki What Does Another Facilities Education Status Have To Do W/ An Independent Lab?

    Yes, we are an independent laboratory, but we do not bill POS 81. We bill the POS where the biopsy was taken Yes, all CPT’s have a PC/TC. The pathologists work for our lab. Manually We get denials for overlapping in/out patient stays occasionally, but never for a facilities educational...
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    Wiki What Does Another Facilities Education Status Have To Do W/ An Independent Lab?

    Help! We are appending the 26 modifier to thousands of claims b/c the facilities where the biopsy’s come from is supposedly an educational institution. I can’t find a single Medicare policy or guideline on this and neither the VP nor the RCM manager know why we’re doing this. 1/2 of the claims...
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    Wiki Place of Service - For Independent Labs

    I’m running into the same issue. We’re being flooded w/ rejection letters from Anthem/BCBS stating we should bill our local even though there’s a 2012 mandate that states we must bill the state in which the specimen was taken. Almost all of the claims were billed w/ POS 11. We don’t seem to...
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    Wiki Laboratory Billing

    Hello! I work for an independent lab that receives biopsies from physicians all over the US. We do not receive biopsies from other laboratories. Lately we’ve been inundated with rejections from Anthem/BCBS to bill our local even though we’re required to bill the state in which the biopsy was...
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