1. L

    Wiki Humana Mod -79 Denial

    Hi, I have noticed denials from Humana on procedures billed with mod -79 performed during the global of another procedure. Commonly seen on cataract surgery done on the opposite eye during the global period of the first eye. Practice is also billing with laterality mods. For example, first...
  2. T

    Wiki Humana denial- Looking for guidance.

    I'm confused about forwarding billing onto patients with Humana. My practice is asking that I forward non-covered services to the patient when they are denied by humana plan. Since it is a Medicare replacement, can I do that? I thought it had to be written off because it is denied by insurance...
  3. E

    Wiki Denial of exam with modifier -24

    Hello, If a payer (Humana) denies an exam with modifier -24 and we have sent in an appeal with documentation showing it is unrelated to the global period what recourse do we have or what can I cite to show that we have billed it correctly and met all the criteria and they are in violation...
  4. RaveenaS

    Wiki Humana Denial for Missing Hernia Modifier {Redacted Op Provided}

    Humana has sent a letter explaining the claim is denied for missing a required modifier to the primary procedure code. I've reviewed this so many times myself, with my coding team, and I've contacted Humana but the rep state they cannot provide any coding recommendation as they are not part of...
  5. N

    Wiki Bundled Office Visit w/ -25

    We have been getting denials recently from Humana when billing 99214-25 (I70.233, F17.218, I89.0) 11042 (L97.312, L97.212, T81.31XA) Dx are different for each code. Only thing I can think of is the i70.233 and L97 codes both address the 'right leg' .. BUT we have been getting paid before with...
  6. KStaten

    Wiki Humana Denials: Why Does Humana Request Bilateral Modifier 50 for Non-Bilateral Body Parts?

    Hello Everyone. :) Does anyone else have issues with Humana denying injections for non-bilateral body parts (such as a left shoulder and right knee injected on the same visit) because they are requesting the bilateral modifier 50, rather than the correct LT/RT; XS modifiers ? Is there a way to...
  7. A

    Wiki 88305 Bone Marrow cases to Humana

    We are billing pathology services for bone marrow cases. I have not been able to determine why Humana will deny 88305 or 88305x2 (bone marrow biopsy and/or clot) for bundling. We have called Humana and they are unable to tell us what it is bundling to. Does any else get this denial and have you...
  8. A

    Wiki Billing 99213, 11721 & 11055 Humana

    I am having a hard time getting the any office visit code (99212, 99213, 99214) 11721 & 11055 all paid by Humana. I have always had trouble with this insurance bundling these services and only paying for the lower dollar amount item (this example 11055 was the only one paid). This is how I...
  9. M

    Wiki HELP!!!! Hopice/Home health billing!

    I work for a Home Health agency and have billed claims for a patient beginning on 5/3 the patient was discharged from Hospice on 5/2 the patient's insurance (Humana) has denied the claims stating "due to the fact that the patient was under hospice care." I have appealed the decision showing that...
  10. M

    Wiki Humana audit and sequestration applies

    We have receive a LOT of Humana that they have took back money stating the allowable is more than they had originally stated and taking back on over 500 claims so far from 2015, 2016. but when I checked the mcr allowable for non facility, they were still not at mcr allowable, so I am trying to...
  11. E

    Wiki Medicare Risk Adjustment & HCC Provider Educator Seattle Area

    MRA Provider Educator- Federal Way, WA-157514 Role: Learning Facilitator Location: Federal Way, WA We’re looking for associates who are dedicated to service and believe in following the Golden Rule of treating others the way you want to be treated. Humana was founded on this premise...
  12. T

    Wiki Humana denial

    Our patient underwent carpal tunnel surgery. Humana has denied the claim stating a modifier is required for this procedure. The other coder in our office & myself were discussing the fact that since ICD-10 has expanded diagnosis codes (like this one) to included specific location, is a...
  13. S

    Wiki **** Humana is fixed**** innaproptiate denials of well visits

    After working the insurance commissioner and Humana all claims processed from 12/12/15 to 01/16/16 should be reprocessed and paid correctly. They stated that there was an internal error where claims with a 25 modifier and 59 modifier were being denied incorrectly. I was able to locate a claim...
  14. A

    Wiki Humana Denial

    Is anyone having trouble with Humana not paying office visits, even with a mod 25 attached? These are all being denied in our office and bundled with lab services or vaccines. Does anyone have any thoughts are how to correct?
  15. J

    Wiki Humana denying any OV billed with any testing or vaccines at the same visit

    Did anyone else start receiving denials for O.V mid December anytime it was billed with any vaccine or testing ( 87880,86308, ect) ? We are pediatrics...and yes we are billing with the correct modifiers. Its across the board, not even plan specific within Humana. I'm reaching out to my Humana...
  16. P

    Wiki Humana not paying for WCC when immunizations billed

    Even though we have modifier 25 on the preventive visit line, lately Humana has been denying it saying, "This procedure code was not reimbursed because the service was included in another service provided at the same time." Any suggestions?
  17. S

    Wiki HUMANA VS Well visits and immunizations

    Help, I have tried speaking with customer service and have now had to send a request to high up contacts. Has anyone noticed that Humana stopped paying for the Well visit when the patients have immunizations. They can give me no information on this. I've ran the codes and they do receive any...
  18. S

    Wiki HUMANA denial for J02.9 not allowed as primary

    We just received a denial from Humana insurance stating that J02.9 is an invalid primary dx code. I do not see any specific guidelines for that code saying it cant be primary. Can someone please let me know if they are having trouble with this also. Thank you
  19. D

    Wiki Humana and DMEs

    Please help. My podiatry practice bills out for DME products such as post-op shoes and pneumatic walkers. Humana has lately been denying them for incorrect modifiers. We have used LT, RT, Medicare modifiers, any modifiers we can find to try to get these paid for. Has anyone else had this...