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    Wiki SERVICING PROVIDER WASNT PAR FOR DOS

    Hi, So I did get an answer back saying her address was accidentally termed.
  2. P

    Wiki PROVIDER OUT OF NETWORK

    Thank you so much for help! Thank you!
  3. P

    Wiki PROVIDER OUT OF NETWORK

    Thank you so much for your help!
  4. P

    Wiki PROVIDER OUT OF NETWORK

    One of our providers is out of network and Anthem is paying the subscriber. The member does not want to cash the check. Wants to wait for the provider to be credentialed (which we are working on). Does she have to cash the check?
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    Wiki CREDENTIALING WITH ANTHEM

    Hi Lady T, Thank you for answering. We are in CT., and there is some miscommunication going on in the background between Carelon and Anthem. We just need to get in touch with the right person to help us. My credentialing person is having a hard time. Thank you, Pamela
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    Wiki BEING PAID OUT OF NETWORK

    One of our providers is being paid out of network and she is credentialed. The Admin is telling me she is all set to bill, but apparently not. All her claims for this one Insurance Co. is paying either out of network or being denied because this service/equipment /drug is not covered under...
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    Wiki CREDENTIALING WITH ANTHEM

    One of our providers just got her LMFT license and she is credentialed now with Anthem. Why are some claims being paid out of network or not being paid at all? This is so frustrating. Can someone please help? Thanks, Pamela
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    Wiki TWO DIFFERENT PROCEDURE CODES SAME DAY WITH SAME PROVIDER

    Can we bill Medicaid for two different procedure codes with the same provider on the same day?
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    Wiki SELF PAY CT

    Thank you Thomas
  10. P

    Wiki SELF PAY CT

    It's United Health Care Medicare
  11. P

    Wiki SELF PAY CT

    Is it OK if the provider does not want to use the patient's insurance, and asks them to self-pay? We are in CT. Thank you
  12. P

    Wiki DX CODES F31.9 AND F33.1

    Thank you for help Susan.
  13. P

    Wiki DX CODES F31.9 AND F33.1

    My claims are being denied from Humana Medicare because they don't like F31.9 and F33.1 together. My provider has been using these dx codes together for years with another Insurance. Can she just use the F31.9 without the F33.1? Thank you!
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    Wiki SERVICING PROVIDER WASNT PAR FOR DOS

    Thank you!
  15. P

    Wiki Anthem

    Thank you Thomas! I always appreciate your help.
  16. P

    Wiki SERVICING PROVIDER WASNT PAR FOR DOS

    Thank you Thomas, I did call CAQH and the provider is credentialed with Anthem. I'm in CT, I was told to contact Carelon to see if the provider is credentialed with them. Would that be right? I really appreciate your help!
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    Wiki SERVICING PROVIDER WASNT PAR FOR DOS

    Hi, A letter from Anthem states THE SERVICING PROVIDER WASNT PAR FOR THE DOS AND SHOULDNT BE SUBMITTING CLAIMS UNDER PAR GROUP TAX. Who do I contact regarding this? The claim is not on file, it is not a denial, do I contact credentialing? This provider is credentialed. Thank you, Pam
  18. P

    Wiki Anthem

    Hi, I'm getting letters from Anthem Blue Cross and Blue Shield of CT saying our TAX ID is not on file, and it is. Can someone please help me with this? I've gotten several letters asking for our W9. Is this because Anthem is now Carelon? Does this have to do with the payer id? Thank you
  19. P

    Wiki Incorrect date of service

    Thank you Thomas!
  20. P

    Wiki Incorrect date of service

    Hello, My charger put in the wrong DOS, so this patient has 2 dos for the same day, and they are United Health Care Medicare. They cannot have 2 visits on the same day. The wrong dos already went out, but the other is on hold. Should I keep the one on hold until I send a corrected claim for...
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    Wiki CREDENTIALING

    Thank you! I'm not going to balance bill the patient.
  22. P

    Wiki CREDENTIALING

    If the payer does not backdate, the original claim left the patient a coinsurance of $15.07. Do I bill the patient?
  23. P

    Wiki CREDENTIALING

    Hi, We have a provider that is credentialed with Anthem (our credentialing person did not know she had to be credentialed with Carelon). The claims were sent to Anthem, and they came back paying UNDER the allowed amount. Reason code CO-131- Claim specific negotiated discount. Once the...
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    Wiki UNITED HEALTH CARE MEDICARE

    Thank you so much!!!!
  25. P

    Wiki UNITED HEALTH CARE MEDICARE

    I have a question regarding United health care wants medical records for January and February of last year on this one patient. The provider put the wrong code on his CHARGE sheet and wants to know if we can correct the code and rebill? The cpt code on the charge does not coincide with the...
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    Wiki CHANGE A CPT CODE

    Hi, Can we change a cpt code that has been paid from 2022? Thank you, Pamela
  27. P

    Wiki Behavioral Health/Hospice

    Hi, Our provider saw a patient that was in Hospice, and we are a Behavioral Health facility. Medicare denied the claim because the attending physician was not on the claim. I never experienced this before with a patient being in Hospice. Can someone clarify for me? Thanks, Pam,
  28. P

    Wiki CREDENTIALING

    Thank you so much Sharon!
  29. P

    Wiki Credentialing

    Good Morning, We have a provider that just got licensed. We bill out under our group practice. Does that mean that this provider does NOT need to be credentialed? Thank you, Pam
  30. P

    Wiki CREDENTIALING

    Good Morning, I have a question on credentialing. We have a provider that just got licensed. We send our claims out as a group practice. Does that mean this provider does not need to be credentialed? Thank you, Pamela
  31. P

    Wiki SEQUESTRATION

    Why is Medicare charging us a Sequestration fee?
  32. P

    Wiki 90791

    Hello, We have a doctor that is transitioning from his Private Practice to our Practice, (bringing in his clients) and wants to know if he can use a 90791 for their first session even though he is already their therapist and treatment isn't newly beginning from a clinical perspective? I know...
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    Wiki 90792

    Thank you so much for your help!
  34. P

    Wiki 90792

    The 90792 was denied because the provider used it twice within the same year. I let the provider know this, and she told me this person was discharged and came back, so the 90792 is correct. I appealed giving Anthem medical records for the first psych eval 90792, the discharge summary, and...
  35. P

    Wiki APPEAL KEEPS DENYING

    After a second level appeal denies, can we keep trying to appeal?
  36. P

    Wiki INSURANCE CLAIMS NOT PAID

    Thanks so much!
  37. P

    Wiki INSURANCE CLAIMS NOT PAID

    This is very helpful! Thank you!
  38. P

    Wiki INSURANCE CLAIMS NOT PAID

    Thanks so much for your help!
  39. P

    Wiki INSURANCE CLAIMS NOT PAID

    Hi, We have an insurance carrier that is a religious cost share. They still owe us from over a year ago. Every time we call they say the same thing; "we have been updating our software, we apologize for the delay". They did give us claim #'s (Need #'s). My question is, can we bill the...
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    Wiki Can a patient be seen twice in 1 day if they have Anthem?

    We billed a 90834 and a 90847 on the same day with 2 different providers. Anthem denied the 90834 per NCCI edits. Is that correct?
  41. P

    Wiki 2% CMS MANDATE

    I'm getting a 2% CMS Mandate on my Wellcare EOB's. What is that?
  42. P

    Wiki 90834 AND 90847

    Can we bill Anthem a 90834 and a 90847 with different providers on the same day? The 90847 was paid, but not the 90834.
  43. P

    Wiki BILLING QUESTION

    We charged Medicare a 90834 and they paid. After they paid, the provider wanted to change it to a 90832. What to do?
  44. P

    Wiki REASON CODE PR-275

    This plan is secondary.
  45. P

    Wiki REASON CODE PR-275

    Is reason code PR-275 patient's responsibility? Is this something new for Blue Cross/Blue Shield?
  46. P

    Wiki 2022 MEDICARE FEE SCHEDULE FOR BEHAVIORAL HEALTH

    Thank you Susan.
  47. P

    Wiki FEE SCHEDULE MEDICARE

    Is there a Fee schedule for 2022 for behavioral health? If so I am having trouble finding it. If someone can please help me. Thanks
  48. P

    Wiki 2022 MEDICARE FEE SCHEDULE FOR BEHAVIORAL HEALTH

    I need a fee schedule for Medicare behavioral health. How can I get that?
  49. P

    Wiki Behavioral Health DX CODES

    Are all mental health diagnoses codes excepted by all insurances?
  50. P

    Wiki IS THIS CONSIDERED DOUBLE DIPPING?

    Thanks for your help!
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