Wiki Anthem denials for J1745 infliximab

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MILLINRP

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Is anyone else seeing an increase in denials for J1745, Anthem of Ohio in particular. The same claims paid several months ago are now denied.
denial code 16 lacks information for adjudication and n816 missing incomplete invalid unit of measure
 
How much infliximab was administered?A single unit of J1745 is only 10 mg., which is likely not the dosage given. (invalid unit of measure). Be sure to count the weight of the medication, not the volume (cc) of the injection. Common mistake.
Also, did you get prior auth? Sometimes the denial codes are ambiguous. Check your local Anthem policies to ensure you're billing for what they consider to be medically necessary.
 
I could not find an Anthem policy and the billing did not change from prior months billing. On a FB group I found where others were having the same issue with J1010 and are billing correctly. I thought I would post here to see if others are having the same issue.
 
MILLINRP said:
I could not find an Anthem policy and the billing did not change from prior months billing. On a FB group I found where others were having the same issue with J1010 and are billing correctly. I thought I would post here to see if others are having the same issue.
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I am getting co16 denials but for J3301 and J9040. BCBS rep states invalid NDC for mine. Correct NDC is on the claim. It started in August for me, all were paid prior for the entire 15 years I've been billing these codes to BCBS.
 
Most of my anthem claims are denying for invalid unit of measure, I am lost. I honestly don't know what they want. Any suggestions?
 
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