Author Topic: UBH denying Psych testing codes 96136/96137  (Read 1030 times)

BillingAPP

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UBH denying Psych testing codes 96136/96137
« on: July 17, 2019, 12:28:39 PM »
Hello,
Any assistance in this matter is much appreciated! UBH has been denying claims with 96136/96137 for psych testing. They pay the 96130/96131 but deny the other portion. I have a preauthorization for both sets of codes. We bill all claims for these services at one time when everything is completed. I have contacted our rep and have been working with them, but it has been months now with no resolution.
Has anyone else been dealing with this? Any resolution?

The denial code is 96 Non-covered charge(s) with N130 Consult plan benefit documents/guidelines for information about restrictions for this service.
Online the explanation is: CQ THIS SERVICE DOES NOT MEET COVERAGE REQUIREMENTS AS DEFINED IN YOUR PLAN BECAUSE IT IS RELATED TO A SERVICE THAT HAS BEEN DENIED OR NOT YET CONSIDERED FOR PAYMENT.

A colleague of mine mentioned using  -59 modifier to mark 96136/96137 as a separate service. I'm at my wit's end and any wisdom or assistance is appreciated.

Michele

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Re: UBH denying Psych testing codes 96136/96137
« Reply #1 on: July 18, 2019, 09:49:13 AM »
We also are having issues with UHC and psych testing.  The 96136/96137 should be covered if they are specifically listed on the auth.  But verify if the dx is the same on the claim as it is on the auth request.  We have noticed if the dx isn't identical that causes a denial.  Are they paying any of the lines or denying all of them?  We have had "projects" with UHC where they were supposed to be fixing an issue then running a sweep to correct all claims.  It took over 6 months!
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Re: UBH denying Psych testing codes 96136/96137
« Reply #1 on: July 18, 2019, 09:49:13 AM »