Author Topic: UHC DENIAL FOR GLOBAL OR TC CHARGE  (Read 4677 times)

MROBLEDO

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UHC DENIAL FOR GLOBAL OR TC CHARGE
« on: March 21, 2012, 03:52:43 PM »
I BILL FOR X-RAY SERVICES AND WE USED TO GET PAYMENT FROM UHC EITHER IF I SENT A PROCEDURE CODE WITH TC MODIFER OR JUST NO MODIFER NOW THEY ARE DENYIN STATING I NEED TO BILL WITH 26 MODIFIER BUT I ALREADY SENT A CLAIM WITH 26 MODIFER I NEED TO GET THE TECHINICAL CHARGES PAID CAN ANYONE HELP? OTHER THAN SENDING AN APPEAL OR HAVE THE SAME ISSUE?

agaspard1

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #1 on: March 22, 2012, 08:16:26 AM »
I would check and see if possible any other physicians billed same services or might be a duplicate some where. But An apppeal is needed and bill with the tc mod because 26 is a professional component mod. Make sure when sent attached uhc appeal form from online with a typed appeal letter explaining the reason why should be paid.

Michele

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #2 on: March 22, 2012, 08:30:02 AM »
I'm confused, are you billing for global?  Or just technical? 
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MROBLEDO

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #3 on: March 22, 2012, 10:21:56 AM »
I'm billing only global but i sent a different  claim as 2 separate ones 1 with mod Tc and 1 with mod 26 but still the Tc denies as i need to add modifier 26 and even if I call to reprocess or send a reconsideration form and submit documentation per MEDICARE GUIDELINES with a written explanation I still receive the same denial reason needing a modifier 26.

also the company i work for has multiple facilites set up in different states and we have also gotten denial in IL, IN ,WI AND MI the only state i havent recieved the denial is GA and yes i have double checked its the same UHC claims address or health plan under UHC

Michele

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #4 on: March 26, 2012, 06:24:00 AM »
Sorry but I'm still confused.  If you are doing global, why isn't it being billed on one claim with no modifiers?  It seems that billing 2 claims for the same provider for the same service, one as TC one as 26 would be confusing. 
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MROBLEDO

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #5 on: March 28, 2012, 08:18:05 AM »
Sorry im billing 2 diferent claims for 2 diferent patients but same procedure just one i add modifier and one i bill global, to be able to show no matter which way i bill to UHC they do not pay but they just tell me the same rejection reason for both which is wrong and they cant give me a reasonable explanation, even if i submit documentation favoring my claim to be paid.

Michele

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #6 on: March 30, 2012, 07:00:56 AM »
What do the rejections say?
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MROBLEDO

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #7 on: April 02, 2012, 02:26:18 PM »
"5023 MEDICARE-PROCEDURE REQUIRES MODIFIER 26"

Michele

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #8 on: April 03, 2012, 06:51:32 AM »
I'm sorry, I don't mean to be stupid, but we are still talking UHC right?  Are these UHC Medicare replacement plans?
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MROBLEDO

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #9 on: April 04, 2012, 03:23:00 PM »
YES ACTUALY  THEY ARE

Michele

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #10 on: April 05, 2012, 06:35:37 AM »
Oh ok, that makes more sense.  The Medicare replacement plans have to follow Medicare's guidelines.  It sounds to me like Medicare only allows the professional component for the procedure you are billing.  We have come across that ourselves.  One of our optometrists does a test that for Medicare he is only allowed to bill the professional component, even though he does the complete test.  Other carriers allow global.
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MROBLEDO

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #11 on: April 05, 2012, 08:46:07 AM »
right that's the same with us but the problem is that we bill the xray code a transportation code for the equipment and a setup charge per xray done, now the odd thing is that we receive payment for the transportation and setup codes but not the xray code that is the only one not getting paid, in that case the whole claim would be denied. even more when i send a reconsideration request they state they pay per medicare guidelines and if we have proof that we receive payment from medicare to submit that in along with anything else and i have submitted to united healthcare copies of payments from medicare and medicare billing guidelines for either global charges or xray codes with modifier TC and still they deny my reconsideration, and even odder united healthcare used to pay for the same procedure codes way before there was any 5010 change i started to see a problem on october 2011

Michele

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #12 on: April 08, 2012, 12:27:48 PM »
Ahhh....so this is only recently a problem.  UHC used to cover it before.  So it sounds like you need to reach the right person to get it straightened out but haven't had any luck yet.  Do you have a UHC provider rep?  It really sounds like it is a system issue that they need to get straight.  You shouldn't have to do an appeal with every claim.  I would try the provider rep, explain the problem, have an example where UHC paid in the past and the Medicare documentation and let them get to the bottom of why the problem is suddenly occurring.  If they say that it's being denied correctly then they need to point you to current Medicare documentation that supports their position.

Sorry it took me so so long to get to the root of the issue.  :)
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MROBLEDO

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #13 on: April 09, 2012, 08:28:02 AM »
yeah thats no problem but thats the thing to reach the right person i have tried but there isnt anyone that i can call directly I found a provider relations email and send an email but no reply and i found one for network management but i dont think they are the right department
« Last Edit: April 09, 2012, 08:32:35 AM by MROBLEDO »

Michele

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Re: UHC DENIAL FOR GLOBAL OR TC CHARGE
« Reply #14 on: April 10, 2012, 09:36:49 AM »
Have you tried calling the customer service and asking who is the provider rep for you?  I would call and say "I need to speak to someone who can get to the bottom of this.  This is a huge problem and it needs to be resolved.  Please give me the name and contact info for someone who can get to the bottom of the issue."  Let us know how this ends up.
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