Advanced MD and Humana

priceam

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Local Chapter Officer
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Lehi, UT
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Our office uses Advanced MD as our software. We are trying to bill a rev code 1002 with H0018. Humana will NOT accept the HCPC code with the rev code. Advanced MD will not let us send the claim without the HCPC and the Rev code. Any ideas?
 

campglo

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Humana H codes

You should ask to speak to a tech supporter. Humana has taken a stand of not paying H-codes because they think it is a Medicaid use only . You software should allow you to just have the description of rev code on the UB-04 format.
 

Cavalier40

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Stuart, FL Sailfish Chapter
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You should also double check the VOB, UR and the documentation to see if you should be billing for IP rehab (rev code 0128 for semi private bed) or Residential (rev code 1002). In Florida there is a difference between the 2, both in the ASAM level and definition of treatment.

Inpatient Rehab would be for shorter term stays where medical monitoring is needed and the patient is transitioning to outpatient levels of care such as PHP. This would be under ASAM level 3.5 and billed with the 0128 rev code

Residential is longer term lower intensity care (generally longer than 20 days). This would be under ASAM level 3.1 and billed with rev code 1002. There are some payers that will not cover rev code 1002, BCBS FEP plans is one off the top of my head.

These should not be confused with more intensive medically monitored inpatient and ambulatory inpatient care under ASAM levels 3.7 and 4.

As for the HCPC codes for the exception of PHP, there are no real alternatives to the H codes. (You can use S0201 for PHP) Generally I would bill without a HCPCS if I am just billing as a per diem. In my history billing Humana for treatment, I have not used HCPCS.

Hope this helps
 

Cavalier40

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Stuart, FL Sailfish Chapter
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@campglo

It depends on the pricing model of the plan. Most OON Humana plans will negotiate through Multiplan, however some will go through a U&C model which will pay either on an average reimbursement in the area as determined by Humana or as a % of the medicare allowed (usually 150%-400%)
 

tagenm

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Port St Lucie, FL
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Advanced MD not allowing a rev code without a hcpc

Hiiii I'm also using Advanced MD and am being told the same thing.. we can't bill the rev code 0128 without a hcpc. Did you ever find a solution to this in the system? Anthem doesn't require anything other than the rev code on this type of claim.

Thanks
Tagen
 

crichmond

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Humana will end up requesting medical records if you do not submit the rev code AND HCPCS code. Even if the services do meet the requirements of the code, and you had auth, they will deny the claim (personal experience). I am not sure how they are about processing an appeal because we are in that situation now. We stopped accepting Humana because of this.
 
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