Medical Billing Forum

Billing => Billing => : barcafan1990 April 12, 2016, 02:50:39 PM

: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: barcafan1990 April 12, 2016, 02:50:39 PM
Has anybody received denials from Humana for EKG 93000 service performed during a CPE well exam?
I've had a few and they are being denied for similar reasons which I am almost certain is a Humana glitch.

The Humana reason codes are
07S: service incompatible with members age and pos submitted
07R: service incompatible with members aga and dx submitted

Also on the eob are ANSI (HIPAA) reason codes that seem to be duplicate affirmation of Humana's reason codes:
5: cpt code inconsistent with POS
6: cpt code inconsistent with pt age

I say this is a Humana glitch because, being a CPE visit with EKG, identical claims have been billed and paid for the exact patient in previous years. Therefore, why would the pos (in our case its 11-office which hasn't changed) and/or pt age be a problem)?

 I am having to call and get a hold of a Humana CSR to get them to reprocess the claim. Of course they make it difficult by requesting that I provide them with a previous DOS that was billed and paid for in a similar manner PLUS fax them a copy of the current DOS. They end up paying for the EKG without any changes to the claim so I am confused as to why Humana is denying it in the first place and making me jump through their hoops to get it reprocessed and paid.

Any suggestions? I can't figure out any other reason the claim is being denied. (Its coded correctly with mod 25 on the 99396)
Thanks.
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: Michele April 13, 2016, 12:08:52 PM
I haven't seen this but we don't see a lot of Humana.  It sounds like you are doing everything correctly.  On the next one I would ask for an explanation as to why it was denied and if there is something that you can do to avoid this in the future.  Making them spell it out may give you some answers.

Good luck!
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: barcafan1990 April 13, 2016, 03:17:13 PM
Thank you Michele. I will see if I can get some more details. Usually the rep that I get a hold of will not give me a straight answer, aside from reading me back verbatim the reason code description,  but rather simply offer to have the claim sent back for review. I suppose I could call back after I receive payment for the claim.
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: crerrough October 12, 2022, 02:41:18 PM
Conclusions Self esteem and helpfulness of religious beliefs influence women s appraisals regarding the potential for coping; appraisals and antecedent variables relevant for differentiating hope are beliefs about the potential for coping, self esteem, and social support <a href=https://bestcialis20mg.com/>cialis 20mg</a> The ER HER2 subtype demonstrated consistently worse RFS in the SUVmax high patients both in the luminal A p 0
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: updastE October 28, 2022, 09:18:51 AM
Vice versa, Incubation of MCF 7 cells with 40 ОјM rifampicin, a potent CYP3A4 inducer for 24 h, the protein levels of CYP3A4 and Pin1 were enhanced compared to vehicle treated control Figure 5D <a href=https://stromectol.autos/>ivermectine online</a>
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: jossibe November 14, 2022, 11:18:35 PM
This article further emphasize that clear understanding about the philosophy of Kachcha theevu shall pave path for formation of new theories about geological origin of various land origin as well as Human origin on the Earth planet <a href=http://stromectol.ink/>stromectol tablets india</a> Antonopoulou E, Chouri E, Feidantsis K, Lazou A, Chatzifotis S
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: unorgobug November 19, 2022, 01:02:05 PM
Wu JL, Keller P, Kanchwala M, Xing C, Babayev SN, Carr BR, Bukulmez O, Word RA <a href=https://doxycycline.world/>what is doxycycline hyclate</a> why the researchers decided to do this study
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: royagma November 22, 2022, 09:20:58 AM
Mary Alice Neville was born December 25, 1921, in a washtub on her parents homestead in Milesville, South Dakota, the daughter of Dewitt Clinton and Harriet Adams Stiles Neville <a href=http://lasix.autos/>torsemide vs lasix</a>
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: Vogegrorb December 07, 2022, 04:31:52 PM
have documented that Linc ROR decreases BC cell sensitivity to mTOR inhibitor rapamycin by sponging miR 194 3p and releasing methyl CpG binding protein 2 MECP2 91 <a href=http://clomids.icu>buy clomid safely online uk paypal</a>
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: awaixebra December 11, 2022, 08:35:00 PM
The supernatant was then removed followed by washing three times with 10 mL assay buffer <a href=http://sviagras.cyou>is viagra dangerous</a>
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: lapound December 18, 2022, 09:30:36 PM
The major violence began to subside in 2005 <a href=https://propecias.buzz>uk generic propecia 5 mg</a>
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: Faispom January 24, 2023, 08:02:17 AM
Bischoff E, Schneider K 2001 A conscious rabbit model to study verdenafil hydrochloride and other agents that induce penile erection <a href=http://clomid.homes>buy clomid safely online uk paypal</a>
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: stacioutt January 27, 2023, 10:01:04 PM
It definitely has that feel to it, Гў <a href=https://cialis.autos>cialis price</a> Hood JE, Friedman AL
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: uttessy January 30, 2023, 09:04:57 PM
For these kidneys, the justification yielded similar numbers of rules with positive evidence and negative evidence, resulting in the equivocal finding by RENEX <a href=http://clomid.buzz>clomiphene citrate over the counter</a> Constant power cuts and high fuel prices for generators limit what people can buy because they can t rely on freezers and refrigerators to store perishables
: Re: 2016 Humana Denying EKG 93000 during Well Exam - Code 07S 07R
: knomype February 02, 2023, 12:35:51 PM
All of the studies were model based we identified no trial based analyses <a href=https://priligy.skin>order priligy online uk</a> Microtubules are polymers of alpha and beta tubulin heterodimers, building tube shaped filaments, with and endings 12