claim denials

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    Wiki How to get Compounded medication covered?

    The private pcp office I work for is struggling to get compounded betamethasone covered with any insurance or cms. Previously had been using J0702 for betamethasone Hcpcs, however the med we use is compounded. It started getting denied around May/June due to it being cmpd. We switched to using...
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    Wiki Independence BCBS claim denials

    We have a provider who's local BCBS is Independence in PA. We have been getting denials on claims that we can't seem to correct. Each claim has been an out of state policy, not an Independence plan. The provider is an Out of network provider with a DME supplier specialty. The codes being...
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    Wiki UHC SNP Program Not Paying Medicaid Portion

    We have a few patients with UHC SNP programs with this issue. UHC is processing the Medicare portion and leaving the copay/deductible to the patient and not paying the Medicaid portion. When submitted to Medicaid, they state that they have already paid UHC for contract services and that UHC is...
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    Wiki Auto Drop of Claims Query

    Hi Everyone: I'm not sure if this is the right forum for this, but nothing else seemed to quite fit. Our employer has recently made the decision to Auto Drop claims for our providers who they claim meet coding accuracy that allows this. They state that 80% of providers industry wide are...
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    Wiki Nevada Medicaid Denials

    I am new to medical billing. I work in a public health clinic and we bill for immunizations primarily. The claims were first denied because our provider wasn't linked to our Medicaid group. After that was fixed I did a little research and I now know that Medicaid will not cover the vaccines...
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    Wiki cpc with outpatient, hospital and facility experience

    Nichole Morris, CPC NicholeHMorris85@gmail.com Medical Billing & Coding Accomplished professional with solid background in health care clinical operations, including medical billing and coding standards, financial policies, and medical record documentation. Expertise in insurance...
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    • Forum: Resume Postings
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    Wiki What is insurance claim denials and re-submission

    What are the best practices to reduce health insurance claim denials and resubmit / handle returned claims? I need to know about the process to help maximize claim approvals. Thanks.
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