Author Topic: Behavioral health claims upfront denials from ANTHEM  (Read 227 times)

Mandy1986

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Behavioral health claims upfront denials from ANTHEM
« on: February 18, 2020, 01:51:27 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.



Michele

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Re: Behavioral health claims upfront denials from ANTHEM
« Reply #1 on: February 19, 2020, 06:44:42 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.
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Nick D

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Re: Behavioral health claims upfront denials from ANTHEM
« Reply #2 on: February 19, 2020, 09:10:18 AM »
Please provide the Type of Bill and HCPC/Rev combo you're using..
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Mandy1986

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Behavioral health claims upfront denials from ANTHEM
« Reply #3 on: March 17, 2020, 10:23:13 AM »

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

Michele

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Re: Behavioral health claims upfront denials from ANTHEM
« Reply #4 on: March 17, 2020, 11:37:21 AM »
So these must be on two separate claims if you are billing two different TOBs.  Are both claims being denied with the same reason?
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