Wiki AMBULANCE BILLING

[jgielow]

I am hoping someone can help me. I currently bill for an out of network ambulance company to BlueCross/Anthem. On our remits, we keep getting a PR96 non covered services which they have included in the patient responsibility. It is not a co-insurance, deductible, or copay amount. It is literally the entire amount of the claim minus what they paid the patient (because again we are out of network). How would I show that our invoice to the patient? I have tried numerous times to try to find out from the insurance company how it is a non-covered service when they do pay the patient for most of the charge. It just doesn't make sense to me, can someone please help! Thank you

 

[CBLENNIE]

There should be at least one additional code to explain the reason for the denial using CARC 96-Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

What other codes are on the denial from the carrier?