Billing > Billing
UHC DENIAL FOR GLOBAL OR TC CHARGE
Michele:
Oh ok, that makes more sense. The Medicare replacement plans have to follow Medicare's guidelines. It sounds to me like Medicare only allows the professional component for the procedure you are billing. We have come across that ourselves. One of our optometrists does a test that for Medicare he is only allowed to bill the professional component, even though he does the complete test. Other carriers allow global.
MROBLEDO:
right that's the same with us but the problem is that we bill the xray code a transportation code for the equipment and a setup charge per xray done, now the odd thing is that we receive payment for the transportation and setup codes but not the xray code that is the only one not getting paid, in that case the whole claim would be denied. even more when i send a reconsideration request they state they pay per medicare guidelines and if we have proof that we receive payment from medicare to submit that in along with anything else and i have submitted to united healthcare copies of payments from medicare and medicare billing guidelines for either global charges or xray codes with modifier TC and still they deny my reconsideration, and even odder united healthcare used to pay for the same procedure codes way before there was any 5010 change i started to see a problem on october 2011
Michele:
Ahhh....so this is only recently a problem. UHC used to cover it before. So it sounds like you need to reach the right person to get it straightened out but haven't had any luck yet. Do you have a UHC provider rep? It really sounds like it is a system issue that they need to get straight. You shouldn't have to do an appeal with every claim. I would try the provider rep, explain the problem, have an example where UHC paid in the past and the Medicare documentation and let them get to the bottom of why the problem is suddenly occurring. If they say that it's being denied correctly then they need to point you to current Medicare documentation that supports their position.
Sorry it took me so so long to get to the root of the issue. :)
MROBLEDO:
yeah thats no problem but thats the thing to reach the right person i have tried but there isnt anyone that i can call directly I found a provider relations email and send an email but no reply and i found one for network management but i dont think they are the right department
Michele:
Have you tried calling the customer service and asking who is the provider rep for you? I would call and say "I need to speak to someone who can get to the bottom of this. This is a huge problem and it needs to be resolved. Please give me the name and contact info for someone who can get to the bottom of the issue." Let us know how this ends up.
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