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Wiki MILD Procedure-62330-Help/Advice needed.

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leigh@lafayettepaincare.net

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We are having major issues with this procedure after switching from AdvancedMD to Prognocis. We have been getting denials from UHC Advantage plans stating they need the EOB from Medicare and Humana first kept saying that the Clinical Trial number wasn't even on the claim and now says, "MEDICARE ADVANTAGE PLANS DO NOT COVER CLINICAL TRIALS, ONLY INVESTIGATIONAL DEVICE EXEMPTION (IDE) STUDIES AND CLINICAL STUDIES APPROVED UNDER COVERAGE WITH EVIDENCE DEVELOPMENT (CED) OR ROUTINE CARE ITEMS AND SERVICES RELATED TO IDE DEVICE STUDIES."
I saw a post in the forum's history that you need to bill Medicare first and then send the denial EOB to the advantage plan. However, These are only recently. We have been coding and putting the same information as we did prior to the switch in systems.
 
jkyles said:
Are they aware that the new codes have a payment status of A?
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Probably not.. pardon my ignorance... we actually do not have a coder on staff...which is why I'm having so much trouble. Do these Medicare clinical trials always go on a CMS-1500 even for institutional? That was my other thought. I'm just at a loss at this point.
 
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