1. N

    Anthem OV Denials

    Hello, we have been having a ton of anthem claims being denied because of 99213 being bundled with Medicare (MIPS) codes. IE, G8427, G9903, G8417. The claims are sent electronic and the values for all of them are 0.00. We have tried getting and answer but no one at Anthem seems to understand...
  2. R

    Wiki Tumescent, Lymph-Sparing Liposuction for Lipedema Reimbursement

    I would like to help with the many misconceptions concerning treating lipedema with tumescent, lymph-sparing liposuction [FEB 2020]. This is considered reconstructive surgery, medically necessary, and reimbursed by some (but not all) insurance carriers. Most have to be appealed at least one...
  3. K

    Anthem BCBS Denying 2nd Eye Cataract Surgery

    Is anyone having issues with Anthem denying/rejecting the second eye cataract surgery within global of the first eye as "modifier used is inconsistent with procedure?" 66984 - RT w/ ICD-10: H25.811 66984 - 79, LT w/ ICD-10: H25.812 We have never had issues before and cannot get through to a...
  4. I

    Help with billing Anthem and Tricare S9494

    I'm hoping someone has an idea what we can do to override a problem we are having between Anthem BCBS and Tricare for Life. We are an infectious disease clinic and many of our patients opt to infuse themselves at home rather than come to the clinic daily. We are not involving a home health...
  5. V

    Radiology Payer Steerage to Free-Standing Imaging Centers

    In 2017, Anthem announced it would begin steering patients to free-standing imaging centers as a cost-saving measure. Rather than pay higher rates to facilities, Anthem required authorization to cover high-res imaging in the Hospital Outpatient setting. Special circumstances, patients under...
  6. M

    Anthem Denials for Substance Abuse

    Beginning March 1, 2018 our California facility began receiving denials for our institutional claims and are now requesting medical records. We are aware that the codes do change twice a year but this is more than that. We are looking for advice from fellow substance abuse billers. Has anyone...
  7. N

    Anthem Virginia and 01996

    Anthem is telling us they need an anesthesia modifier on CPT 01996 (AA, QK, etc). I'm a new coder, and it doesn't look correct. I'm curious if anyone else is having the same issue? Are you adding a modifier or are you fighting it?
  8. D

    Fee schedules

    Please help :-) I know medicare 2016 fee schedule is not available yet. Aetna and Cigna i am not sure where to look. and BCBSIL I know there is a form that needs to be filed out. Anthem I am not sure on either. Can someone please send me in the right direction. This is for the state of...