Wiki Help!!! Ambetter denials

[cakins@eastsideinternalmedicine.com]

I am suddenly getting denials from Ambetter where they are denying the physical cpt and paying the admin. I used 99395 =25, 90662 and 90471. They denied for bundling. Can someone help me please??

 

[SharonCollachi]

Doesn't Ambetter use G codes instead of 90471-90472 and a Q code for the vaccine?

Check your provider manual. You didn't mention your state, or I would try to link you.

 

[Trenishab]

Doesn't Ambetter use G codes instead of 90471-90472 and a Q code for the vaccine?

Check your provider manual. You didn't mention your state, or I would try to link you.

Hi Sharon,

I'm in Georgia and wee're having the same problem with denials from Ambetter when 99214-25 is billed with 90471-59. These are commercial plans. Any advice. Please and thank you.

 

[teedowning@comcast.net]

I am suddenly getting denials from Ambetter where they are denying the physical cpt and paying the admin. I used 99395 =25, 90662 and 90471. They denied for bundling. Can someone help me please??

Hi, I have emailed our provider representative and she stated that there is a issue with their system. My advice is to put your claims on a spreadsheet and get them to your provider representative asap. Your other option is to file an appeal for each claim which we have been doing. If no result, report then to the GA insurance commissioner. The claims are denying for the 25 modifier. Keep me posted.