Hello - do you bill with regular CLIA or do you have the CLIA waiver ?
- We bill:
- 87635 – COVID-19 (SARS-CoV-2)
- 87581 – Mycoplasma pneumoniae (Under Infectious Agent Antigen Detection)
- 87486 – Chlamydophila pneumoniae (Bacterial ID)
- 87798 Bordetella pertussis - PCR testing for microbial identification - amplified prob
- 87798-59 Bordetella Parapertussis - PCR testing for microbial identification - amplified probe UHC is denied it stating we need to bill with panel code (each line denial) ncci edit denial
- For the 87631 panel here are organisms that could be considered 87798 -coder recommends billing 87631 under 87798
Organism/Virus CPT Code Code Description Adenovirus 87798 Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified Influenza virus 87798 Influenza A/B (without RSV) Coronavirus (not SARS-CoV-2) 87798 For common human coronaviruses (229E, NL63, OC43, HKU1), use 87798 per organism Metapneumovirus 87798 No specific code; billed under 87798 Parainfluenza virus 87798 Types 1–4 fall under 87798 per organism Respiratory Syncytial Virus (RSV) 87798 RSV by amplified probe technique – specific code exists Rhinovirus (or Enterovirus) 87798 if coded individually No specific code; use 87798 for rhinovirus unless part of a panel
This is what is rendered:
87635 - PCR testing for microbial identification - amplified probe.
severe acute respiratory syndrome coronavirus 2 (SARS-CoV) (Coronavirus disease [COVID-19]), amplified probe technique
87631 - PCR testing for Coronavirus COVID-19 up to 5 respiratory pathogens
Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets
Influenza AH1
Influenza AH1-B
Influenza AH3
Influenza B
Rhinovirus/Enterovirus
Adenovirus
Human Metapneumovirus (HMPV)
Human Parainfluenza virus1
Human Parainfluenza virus2
Human Parainfluenza virus3
Human Parainfluenza virus4
Coronavirus 229E
Coronavirus NL63
Coronavirus OC43
Coronavirus HKU1
Respiratory Syncytial virus A
Respiratory Syncytial virus B
87581 – Mycoplasma pneumoniae - PCR testing for microbial identification - amplified probe
87486 – Chlamydophila pneumoniae - PCR testing for microbial identification - amplified probe
87798 – 2 units: Bordetella pertussis - PCR testing for microbial identification - amplified prob
Bordetella Parapertussis - PCR testing for microbial identification - amplified probe
Call the clearing house customer service first. Sometimes it is an error on their side and has nothing to do with the plan. They are very helpful. You can also open ticket/case# via UHC.com chat. Uhc.com scroll down to contact us Chat "bubble" will pop out. Try to request review by manager/open case. They should give you case#. this is the fastest way I can think of right now.Claim to UHC fail at our clearing house due to :A3-21.CLAIM HAS BEEN REJECTED AS UNPROCESSABLE. MISSING OR INVALID INFORMATION..P4999UCCIPZ SMARTEDIT (UCCIPZ) PATTERN 50987 PROVIDER ZIP CODE ****** SUBMITTED ON THE CLAIM DOES NOT MATCH ZIP CODE REGISTERED WITH CLIA ******. PLEASE UPDATE CLAIM AS APPLICABLE"
Despite reviewing UHC's SmartEdit requirements and reaching out to UHC directly, we have not been able to get a clear explanation as to why the claims continue to fail. As a workaround, we are forced to mail these claims, which significantly delays our reimbursement. Once mailed, the claims are processed and paid.
Lab codes being billed include:
- We have multiple office locations.
- Our CLIA certificate is a Compliance type at one location, and Waiver type at all others.
- This issue only occurs with UHC and only when billing lab services.
81002, 81007, 81025, 87491, 87591, 87661, 87624, 82670, 84144, 84443, 84439, 83001, 83002, 82627, 84403, 84146, 84270, 84702, 82306
I would appreciate any guidance or feedback on how to resolve this issue permanently, so claims can be submitted electronically without delay.
Claim to UHC fail at our clearing house due to :A3-21.CLAIM HAS BEEN REJECTED AS UNPROCESSABLE. MISSING OR INVALID INFORMATION..P4999UCCIPZ SMARTEDIT (UCCIPZ) PATTERN 50987 PROVIDER ZIP CODE ****** SUBMITTED ON THE CLAIM DOES NOT MATCH ZIP CODE REGISTERED WITH CLIA ******. PLEASE UPDATE CLAIM AS APPLICABLE"
Despite reviewing UHC's SmartEdit requirements and reaching out to UHC directly, we have not been able to get a clear explanation as to why the claims continue to fail. As a workaround, we are forced to mail these claims, which significantly delays our reimbursement. Once mailed, the claims are processed and paid.
Lab codes being billed include:
- We have multiple office locations.
- Our CLIA certificate is a Compliance type at one location, and Waiver type at all others.
- This issue only occurs with UHC and only when billing lab services.
81002, 81007, 81025, 87491, 87591, 87661, 87624, 82670, 84144, 84443, 84439, 83001, 83002, 82627, 84403, 84146, 84270, 84702, 82306
I would appreciate any guidance or feedback on how to resolve this issue permanently, so claims can be submitted electronically without delay.