tricare

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    Wiki Reimbursement for Orthognathic surgery from Tricare

    Normally we bill dentally for most of our dental procedures. There are the few medical but set fee schedules help determine the over all out of pocket cost for patients. In billing medical for Orthognathic surgery, mainly Tricare, if we have the authorization/approval letter, how do I bill out...
  2. I

    Wiki 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...
  3. J

    Wiki Tricare refunds due to invalid NDC

    Someone familiar with Tricare billing: Please Help! A few months ago, our practice began receiving multiple Tricare refund requests due to "the recommended drug/vaccine dosage for the National Drug Code (NDC) units from the manufacturer has been exceeded." The claims listed were from 2013-2016...
  4. S

    Wiki Tricare and presumptive urine drug testing

    Tricare has been denying all my presumptive urine drug tests stating non covered, I've been using the new 80305 code. I spoke with a rep at Tricare who tried to change the code to G0477 but this came back as termed like I tried to explain, at this point I can't get any presumptive testing to pay...
  5. K

    Wiki Tricare and lipid panel

    Does anyone know Tricare's guidelines for coverage of a wellness lipid panel? I am seeing several claim denials in regards to the patient's age. The only thing I can find on their site is this "TRICARE covers age specific, periodic lipid panels as recommended by the National Heart, Lung and...
  6. S

    Wiki Tricare

    Help, I am new in the pediatric field. We have received letters from Tricare saying that they over paid immunizations billed out. I do not have any documentation where they were instructing providers to change the NCD units to 1 from .5 to get the claims to pay correctly. I have researched...
  7. R

    Wiki Problems with deciding whether a modifer 50 should be used or right and left

    I have noticed that different insurance companies are requiring right and left when performing bilateral procedures vs the 50 modifier (bilateral procedure). Does anyone have documentation on what Tricare demands? I cannot get an answer from them. Would appreciate any help you can give me...
    • rmalashuk
    • Thread
    • bilateral demands left modifier tricare
    • Replies: 1
    • Forum: Modifiers
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