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Wiki BCBS Medical Necessity Denial

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kristina2288

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Hi All! Hoping someone can help me out. We have been put on prepayment review for BCBS which means we need to submit medical records for all codes billed with a Transvaginal sonogram. We have done so for all patients (2-3 page E&M, 2-3 page Ultrasound report). BCBS has constantly come back on over 15 claims stating that the codes billed do not match the medical records provided - we have been billing 99214 or 99213, 76830 and 93976(59) since we also do a doppler (and the measurements and documentation is provided to them as well). The denials state only "records do not match codes" - i have appealed the denials and requested a formal breakdown and each code why its not covered but they are not complying and the off-shore reps refuse to transfer me to onshore supervisors or the adjustment department. Has anyone gone through this? PLEASE HELP
 
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