Medical Billing Forum

Billing => Facility Billing => : Mandy1986 August 22, 2019, 01:01:35 PM

: Emblem
: Mandy1986 August 22, 2019, 01:01:35 PM

Hi
i have discus something about a billing part for a patient currently with us. we are getting denial for her claim as DIAGNOSIS WAS OMITTED OR INCONSISTENT WITH PROCEDURE/REVENUE CODE 

DX used for billing :DX1: F31.13, DX2: F43.10, F12.20
Revenue Code: 913   
CPT :H0035
PHP-MH
Bill type:131
 Can someone assist me ?


 

: Re: Emblem
: Mandy1986 August 22, 2019, 02:20:07 PM

Insurance Name : Emblem Health


https://www.emblemhealth.com/

: Re: Emblem
: Michele August 27, 2019, 04:54:03 PM

It is not possible to tell based on the information below.  Have you tried calling Emblem?

: Re: Emblem
: Mandy1986 August 28, 2019, 11:37:52 AM

Yes, They told per there coder DX codes :F31.13, F43.10, F12.20 not support Revenue Code: 913  CPT :H0035, Bill type :131
 
it is hospital billing Mental health treatment center.

: Re: Emblem
: Michele August 28, 2019, 03:12:57 PM

The dx codes are valid, the rev code is valid, and the type of bill is valid.  There must be something about this specific plan that does not cover partial hospitalization for those codes. 

: Re: Emblem
: Nick D September 12, 2019, 01:26:09 PM

Emblem will only accept Rev 912. Hope that gets you paid!

: Re: Emblem
: Mandy1986 September 13, 2019, 12:12:10 PM

thank you Nick D. Yes,  It worked :)

: Re: Emblem
: Nick D September 13, 2019, 02:46:13 PM

Awesome   8)