Wiki Anthem downcoding

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karys84

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Is anyone else having Anthem downcoding their claims without asking for notes. So for example we billed a 99214 but they're processing it as a 99213. The denial code is CO-186 (payment adjusted since the level of care changed) Any input is greatly appreciated.
 
Yes, we are having this with our group. We have been submitting a PAR form with chart notes to Anthem disputing these. Some have come back and paid appropriately. Anthem actually started doing this at the end of 2020 but we didn't realize it until this year. Since we have been fighting these, Anthem has started processing some of our providers at the level billed.
 
We are having the same issue here. We too have been fighting them, they told us they were going to start processing the claims at level billed, we are still waiting for that to happen.
 
Thanks for fighting back on these. An insurance should never change the code level without documentation. If they question the code level, they should be asking for documentation. If others don't fight it they will just keep on doing it. Thanks for not just "letting it slide".
 
jessicaw412@gmail.com said:
Yes, we are having this with our group. We have been submitting a PAR form with chart notes to Anthem disputing these. Some have come back and paid appropriately. Anthem actually started doing this at the end of 2020 but we didn't realize it until this year. Since we have been fighting these, Anthem has started processing some of our providers at the level billed.
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May I ask where you're located. I'm in Indiana.
 
jessicaw412@gmail.com said:
Yes, we are having this with our group. We have been submitting a PAR form with chart notes to Anthem disputing these. Some have come back and paid appropriately. Anthem actually started doing this at the end of 2020 but we didn't realize it until this year. Since we have been fighting these, Anthem has started processing some of our providers at the level billed.
Click to expand...

I'm having the same issue what's a PAR form?
 
I am located in IN. The PAR form is the Provider Adjustment Form. It can be found on the Anthem Provider website, look under the state that you are located. If you call the claims dept at Anthem they can provide the appropriate fax # for these forms and submit with Medical Records. We have had our claims reprocessing at the correct level. I work for an ophthalmologist group.
 
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