Author Topic: PHP billing with medicare guidelines  (Read 3527 times)

Jen99

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PHP billing with medicare guidelines
« on: April 12, 2012, 04:24:24 PM »
I am having issues getting a claim to process.  The patient has a Blue Cross insurance that follows CMS guidelines.

I have billed PHP for 2 years and have never had a problem getting the claim paid, until now.

I am billing TOB as 893
                Rev code 912 in box 42
                HCPCS code H0035 in box 44

Insurance came back saying:
need valid TOB, Rev code and HCPCS code for valid submission according to CMS guidelines for PHP.

Any help would be great.

Michele

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Re: PHP billing with medicare guidelines
« Reply #1 on: April 16, 2012, 06:36:32 AM »
Well it sounds like they don't like the 893.  Have you considered using TOB 833 or 733?  Different insurance carriers sometimes require different types of bill.  In the past we have used both the 8 and the 7 (leading number of type of bill). 
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Jen99

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Re: PHP billing with medicare guidelines
« Reply #2 on: April 16, 2012, 12:45:50 PM »
I just spoke to a rep at the insurance and they said H0035 isn't a covered code.  Do you know of another HCPCS code I can use for PHP for mental

Michele

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Re: PHP billing with medicare guidelines
« Reply #3 on: April 16, 2012, 07:25:00 PM »
If there is not an appropriate HCPCS or CPT code then that field can be left blank.  Do they allow the 912?  If so I would just put the description in and leave the cpt/hcpcs blank.
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