Billing > Billing

CORRECT FL BLUE OUTPATIENT DETOX CODES

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WhitanyaS:
Hello again,

At capacity, we have 40+ clients rotating in and out so we always file claims as a courtesy to the client, lest we not get paid. Most of our clients are not up to the task of arguing with insurance companies, given their primary Dx.

Believe me, i agree with you; 0944 is a common service so how the heck can it not be on FL Blue fee schedule?! We are truly stumped... Thanks for all the responses!

Michele:
I wish I could think of something to advise you to do!   :'(

WhitanyaS:
Well,

I tried. Thanks for the response.

Whitanya

PMRNC:
If you are out of network, they should be following U&C guidelines and DRG of course...If you have a "denial' you could appeal with description of the code attached. If this is an ERISA claim then you will need the patient to sign an ARF and then i would request from them complete documentation showing why that code is not payable. Even if claim is partially paid and with only that line item being denied, under ERISA it is an adverse benefit determination. Get the patient involved by signing an ARF (ONLY if ERISA). Your other option is to bill the patient and let them handle it.

WhitanyaS:
Hello,

Thanks for the response. There are several patients involved. I'll have to review to see which clients have ERISA plans.

Thanks again,

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