Coding > Coding

speech therapy - communication device

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PMRNC:

--- Quote ---She said they'll deny, but then we can file Medicaid and they will pay.
--- End quote ---

If UHC denies the device for Medical necessity you will have to FIRST appeal and exhaust efforts with them FIRST.. Medicaid will NOT pay or even consider payment if the primary denies for Medical Necessity. You will have to prove Medical Necessity with the primary first.. same with authorization, you must follow and exhaust efforts with primary payor first. If you don't obtain an auth and they deny for auth you will have to then appeal with UHC. Medicaid will be the payor of last resort and only if all procedures are followed for consideration of the claim by the primary payor.
Like Steve mentioned, there are various HCPCS codes, and this will be a DME Code. I would say your best resource for this is to go to the manufacturer for the proper code. 

Anne:
yes, I planned to send in doc. to show medical necessity w/ prim. ins claim.  evidently ST has done this before and thinks it will be denied by United, but maybe it wasn't done properly before.  Not sure why she said United would deny.  And not sure why Medicaid would pay.  I was assuming she must have had some past experience w/ billing for this particular device.  thanks for tip about checking w/ the manufacturer - I didn't think of that. 

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