59426

newfiegirl

Networker
Messages
77
Location
Rochester, New Hampshire
Best answers
0
I am having a problem with UHC paying for this antepartum code. My charge has been denied stating that the the billed from and to date range need to be reported and this code is reported with a single unit and the date range for which the services occurred. I have provided this info as well as medical records as requested to support my claim and I am still being denied. Any suggestions would help as I have not encountered this in the past. Thank you
 

Cmama12

Guru
Messages
166
Best answers
1
Hi, yes, they require the rate range when the individual codes are reported. How are you putting them on the claim? We are entering it as a procedure comment when processing the charge.
 

Leandra

Guru
Messages
164
Location
Grand Rapids, MI
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0
I would check what the UHC policy is for billing prenatal only; some payers want date range of prenatal visits and other payers want only first date as from/to date with other dates listed in notes.
 

newfiegirl

Networker
Messages
77
Location
Rochester, New Hampshire
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0
Thank you. I do not understand the reference to "We are entering it as a procedure comment when processing the charge." Where would that be entered on the claim? My understanding from UHC is that they want the from/to date on the claim. Would you list each date of service on the claim? I am at a loss. Thanks for any help/input.
 

Cmama12

Guru
Messages
166
Best answers
1
Hi, they do want to/from dates as per their policy (below), but no instruction is given on how to provide that information. How do you process your charges? We use Epic and when you right click on a charge line there is a spot for Procedure Comment, which we use for a variety of purposes including the to/from dates. I looked to see if I had any examples I could show you, but nothing at the moment. So far I think this method has been working :unsure:

The dates reported should be the range of time covered. For example, if the patient had a total of 4-6 antepartum visits then the physician and/or other health care professional should report CPT code 59425 with the "from and to" dates for which the services occurred. In the event that all the antepartum care was provided, but only a portion of the antepartum care was covered under UnitedHealthcare, then adjust the number of visits reported and the "from and to" dates to reflect when the patient became eligible under UnitedHealthcare coverage. Commercial Reimbursement Policy CMS 1500 Policy Number 2021R0064A Proprietary information of UnitedHealthcare. Copyright 2021 United HealthCare Services, Inc.
 
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