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Best answers
In the last several months to a year we have one insurer paying then requesting a recoupment on 76519-26 and 92136-26. Now we have a second carrier following suit.

We have appealed sending documentation showing the bilateral indicators for 76519-26 and 92136-26 are 3's indicating it may be billed twice once for each eye. The provider help desk/provider reps tell us the recoupment and/or denials are in error but they are still processed, and we cannot get them reversed. Our administrator will not allow us to report to the State Insurance Commissioner.

We have also had this issue with Medicare however when appealed the decision is reversed, and the claim is paid or the recoupment is cancelled.

Is anyone else having this issue? Has anyone been successful in getting these claims to pay and stop the nonsensical denials?

We have not changed our approach we are billing the same we have for years. Provider reps have not been helpful.

Thank you in advance for your help.