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Behavioral health claims upfront denials from ANTHEM
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Topic: Behavioral health claims upfront denials from ANTHEM (Read 3050 times)
Mandy1986
Newbie
Posts: 14
Behavioral health claims upfront denials from ANTHEM
«
on:
February 18, 2020, 04:51:27 PM »
Hello,
we are currently billing codes per Magellan since we are residential treatment center mental health but anthem not accepting these codes and deny inappropriate combination of revenue/CPT code. specially for PHP mental health.
https://www.magellanprovider.com/media/11704/codingsimplified.pdf
https://www.magellanprovider.com/media/11724/univ_services.pdf
Would request you to please advise if you have any list of codes billing to ANTHEM for these services and claim not deny by them upfront.
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Michele
Administrator
Hero Member
Posts: 5927
Re: Behavioral health claims upfront denials from ANTHEM
«
Reply #1 on:
February 19, 2020, 09:44:42 AM »
Your question in the last sentence is worded odd so I'm really not sure what you are asking. If you are asking for a list of codes that Anthem allows for residential treatment centers I do not have that available. If you are receiving denials for specific rev codes/cpt codes and you post what those codes are we may be able to help.
"and claim not deny by them upfront" - I have no idea what you are asking with this statement.
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Nick D
Newbie
Posts: 40
Re: Behavioral health claims upfront denials from ANTHEM
«
Reply #2 on:
February 19, 2020, 12:10:18 PM »
Please provide the Type of Bill and HCPC/Rev combo you're using..
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OON Facilities Billing Manager
Mandy1986
Newbie
Posts: 14
Behavioral health claims upfront denials from ANTHEM
«
Reply #3 on:
March 17, 2020, 01:23:13 PM »
Revenue Code CPT Description
1001 H0017 RTC-MH
913 H0035 PHP-MH
905 S9480 IOP-MH
300 80305 UA
915 90853 Group-MH
Bill Type: 863 for RTC-MH , 893- PHP-MH, IOP-MH
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Michele
Administrator
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Posts: 5927
Re: Behavioral health claims upfront denials from ANTHEM
«
Reply #4 on:
March 17, 2020, 02:37:21 PM »
So these must be on two separate claims if you are billing two different TOBs. Are both claims being denied with the same reason?
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Medical Billing Forum
Re: Behavioral health claims upfront denials from ANTHEM
«
Reply #4 on:
March 17, 2020, 02:37:21 PM »
Nick D
Newbie
Posts: 40
Re: Behavioral health claims upfront denials from ANTHEM
«
Reply #5 on:
June 05, 2020, 10:01:21 PM »
Billing Anthem is different from billing Magellan.
When billing PHP/IOP use bill type 131.
PHP level of care they like to see Patient Status -01 (routine discharge to home or self care)
Sorry for the late response, hope this helps!
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OON Facilities Billing Manager
Medical Billing Forum
Re: Behavioral health claims upfront denials from ANTHEM
«
Reply #5 on:
June 05, 2020, 10:01:21 PM »
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Behavioral health claims upfront denials from ANTHEM