Has anyone had any success billing home health claims to Anthem of Ohio since the beginning of 2020? We provided services to members with an HRT prefix (Highmark of Pennsylvania), which is a new prefix for our agency. I was told that since we are an Ohio Provider, we had to bill to our local Blue Cross, which is Anthem of Ohio. We were told that we are an out of network provider, so no authorization is needed. Upon submitting the claims, received denials stating that a Treatment Authorization code is required in Box 63. Under the new PDGM system, no treatment authorization code is generated. When I asked the customer service rep about this, she did not have an answer for me. She only re-read the denial reason and said she had no further information for me. I also asked whether a RAP needs to be sent, or if we can just bill a Final claim (which is what we always did in the past). Once again the only answer I received is to follow Medicare guidelines. Has anyone had any success billing Anthem since the start of PDGM? Any help would be appreciated!
