Medical Billing Forum

Billing => Facility Billing => : Mandy1986 February 18, 2020, 04:51:27 PM

: Behavioral health claims upfront denials from ANTHEM
: Mandy1986 February 18, 2020, 04:51:27 PM

Hello,

we are currently billing codes per Magellan since we are residential treatment center mental health but anthem not accepting these codes and deny inappropriate combination of revenue/CPT code.  specially for PHP mental health. 

https://www.magellanprovider.com/media/11704/codingsimplified.pdf

https://www.magellanprovider.com/media/11724/univ_services.pdf

Would request you to please advise if you have any list of codes billing to ANTHEM for these services and claim not deny by them upfront.


: Re: Behavioral health claims upfront denials from ANTHEM
: Michele February 19, 2020, 09:44:42 AM
Your question in the last sentence is worded odd so I'm really not sure what you are asking.  If you are asking for a list of codes that Anthem allows for residential treatment centers I do not have that available.  If you are receiving denials for specific rev codes/cpt codes and you post what those codes are we may be able to help.

"and claim not deny by them upfront"  -  I have no idea what you are asking with this statement.
: Re: Behavioral health claims upfront denials from ANTHEM
: Nick D February 19, 2020, 12:10:18 PM
Please provide the Type of Bill and HCPC/Rev combo you're using..
: Behavioral health claims upfront denials from ANTHEM
: Mandy1986 March 17, 2020, 01:23:13 PM

Revenue Code   CPT   Description
1001                H0017   RTC-MH
913                H0035   PHP-MH
905                 S9480    IOP-MH
300                 80305           UA
915                  90853   Group-MH


Bill Type: 863 for RTC-MH  , 893- PHP-MH, IOP-MH
: Re: Behavioral health claims upfront denials from ANTHEM
: Michele March 17, 2020, 02:37:21 PM
So these must be on two separate claims if you are billing two different TOBs.  Are both claims being denied with the same reason?
: Re: Behavioral health claims upfront denials from ANTHEM
: Nick D June 05, 2020, 10:01:21 PM
Billing Anthem is different from billing Magellan.
When billing PHP/IOP use bill type 131.
PHP level of care they like to see Patient Status -01 (routine discharge to home or self care)

Sorry for the late response, hope this helps!