Billing > Facility Billing

PHP and Anthem Requirements

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Nick D:
Do you bill 6 day a week PHP services? I would also ask them when they are starting and stopping this "week". I had overturned a similar issue with UPMC who denied for "not enough clinical hours in one week" but the client had only admitted on Wednesday so it was impossible to meet their 25 clinical hr requirement. I would also ask if they are looking for a certain amount of clinical hours in a week or if they specifically want 5 6hr days..

Interested in your findings!

At this point Anthem has clammed up about ways we can try and reconcile the issue. They count weeks as Sun thru Sat, what we are attempting now is an initial submission under bill type 892 and then the following claims under 893 in 5 day blocks and if a day is skipped we have a narrative built into our records to explain in a clinical sense why a day was missed.

I hope that works for you.  Crazy how they change things but won't give much guidance.   :-\


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