Search results

  1. A

    Wiki UHC denials M50 - Independent Lab

    Have you spoken with Optum or only UHC?
  2. A

    Wiki AMA email....is this legit? Urgent: Immediate action required for CPT Standard Data File licensing

    They're recently been bugging us about it too.
  3. A

    Wiki UHC denials M50 - Independent Lab

    I also work for an independent laboratory that deals with UHC being ridiculous all the time. Let me check with the UHC specialist in my office and find out what I can. I'll get back to you soon.
  4. A

    Wiki BCBS Local Plan Question

    That's what myself and the BCBS person in my office kept pulling up but we were still getting push back from the ordering provider. We ended up sending multiple states BCBS provider manuals (not just the two states in question) to get the point across. I'm pretty sure the ordering provider...
  5. A

    Wiki Can you change a lab diagnosis after getting a denial?

    Yes, my bad there. Still a good thing to know anyway. The only time I asked after a denial is if they sent me a ton of SDOH codes and I have to go "Umm...anything else you got there that is an actual illness or symptom?" ETA: We do try to catch these before they go out the door but sometimes...
  6. A

    Wiki Can you change a lab diagnosis after getting a denial?

    I've been doing lab billing for a while now and providing the approved diagnosis list is something that we do frequently. It's an education tool more than anything to let providers know that "Hey, we know you're doing the test for X, Y, or Z, but according to (insert payer here) that diagnosis...
  7. A

    Wiki BCBS Local Plan Question

    I work for an independent laboratory that has an ordering provider who straddles a state line. We're getting a bit of pushback regarding what would decide the local plan from the ordering provider because their NPI is registered in one state but the specimens are being ordered and obtained in...
  8. A

    Wiki specific dx code

    I didn't see anything in guidelines either, but if they had other symptoms I would ask the provider about it. It might be an edit in the coding software that you're using. If the patient had a fever and cough, those are probably the better codes to use hence why I would speak to the provider.
  9. A

    Wiki Modifier QW Question

    Okay, so I'm not going crazy. I got my CPB back in June and that's what I read too. You went to the same sources I did so it's nice to know I read them correctly. I'm leaning on the side that they have the wrong CLIA level in their system and need to update it to the correct. This payer updated...
  10. A

    Wiki Modifier QW Question

    I posted this question previously and thought I had found my answer so I deleted it like a dummy. However, I didn't so I wanted to ask again. I work at an independent laboratory that has a CoA CLIA and does urine tox, some molecular testing, and some blood testing. One of our Medicaid payers...
  11. A

    Wiki CMS NCCI Presumptive & Definitive Testing

    No problem! I religiously keep on top of this stuff (my coworkers thing I'm nuts 🤷‍♀️). The crazy thing is they put the old revision on the same day as the new one. CMS gets to their lives together - lol.
  12. A

    Wiki CMS NCCI Presumptive & Definitive Testing

    From the revision history on the article A56915. Emphasis added.
  13. A

    Wiki UT Medicaid Urine Drug Testing Carve-out

    I know this is a rather specific question so even if you have any input that would be fantastic. I've been going back and forth for the last 5-6 years with MCOs in Utah about the substance use disorder (SUD) carve out for UDT. The only place the carve-out is mentioned is in a MIB from April 2018...
  14. A

    Independent Laboratory Biller CPB Focusing on Medicaid and MCOs/ACOs nationwide

    Independent Laboratory Biller CPB Focusing on Medicaid and MCOs/ACOs nationwide
  15. A

    Wiki CMS NCCI Presumptive & Definitive Testing

    I don't have KY Medicaid assigned to me at work, but according to the person who does KY the only one that's paying right now is Humana. We're still holding our KY Medicaid claims so I'm going to assume that we're not getting paid on our test claims either. I've had a bit better luck with mine...
  16. A

    Wiki New Drug Screen CCI Edits

    UHC has been dragging their feet. We have tons of claims sitting in a rejected status until they figure out what they're doing.
  17. A

    Wiki CMS NCCI Presumptive & Definitive Testing

    The G code no longer needs a modifier at all. You can bill the same as before. I think the only exception right now is Minnesota Medicaid.
  18. A

    Wiki CMS NCCI Presumptive & Definitive Testing

    The UDT NCCI edit was deleted 10/1/23 retroactive to 7/1/23. No need to worry about modifier anymore! EDIT: I'm the MCD/MCO guru at my company and we're still dealing with a ton of MCDs and MCOs that haven't updated their edits yet. It's frustrating because we've been holding some of these...
  19. A

    Wiki Provider Out of network, payment going to patients?

    This is something that my lab has to deal with Anthem CO because we're OON with them. My understanding is that there isn't anything you can do; we've exhausted every option we have and they still send them to patients. Patients who have Anthem CO get a notice in their statement explaining that...
  20. A

    Wiki Split Fragmented Billing

    The only time we send multiple claims for the same date is if we ran some tests and so did a reference lab. One claim would be ours and the other one is the reference lab with -90 on it. We also have to "split" due to payer policy at times; some payers won't accept presumptive and definitive...
  21. A

    Wiki CMS Rescinds UDT NCCI Edits

    Good news for my fellow lab billers! CMS has decided to retroactively rescind/delete the urine drug testing NCCI edits back to 7/1/23. I'm not sure what they hoped to accomplish with the edit, but apparently it wasn't the solution they hoped for. If they were looking for ways to put further...
  22. A

    Wiki New Drug Screen CCI Edits

    Medicare, Medicare Advantage, Medicaid, and MCOs. It's up to the commercial plan as to if they want to follow NCCI edits; they're not required to. They usually do, though.
  23. A

    Wiki New Drug Screen CCI Edits

    Not OP, but all we've seen for MCRADV & commercial are some BCBS/Elevance/Anthem payers either never updated to the new edits or have already updated to -59. Everything else is still denying. I'm the Medicaid/Managed Care guru where I'm at, but that's what I'm hearing from others.
  24. A

    Wiki Patient With Medicaid in 2 States - Who would you bill?

    The problem with contacting the patient is that we're an independent laboratory and I have no way to contact the patient except for going back to the referring provider. Unfortunately, going back to the referring provider has to go through two more layers of people before I can get an answer (if...
  25. A

    Wiki Patient With Medicaid in 2 States - Who would you bill?

    I have occasionally come across patients who, somehow & some way, have active Medicaid in two states. For example, they have active Medicaid in Arizona while being active with Medi-Cal at the same time. I've also seen one state have a COB with another state (ex. Nevada Medicaid shows that...
Top