Wiki Billing glasses to Insurance

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19bowers78

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Recently, Premera and now other companies as well have been denying the second lens as duplicate. We usually bill each lens separately and had zero issues for YEARS. All of a sudden Premera started denying the second eye. You call them and they reprocess, and it still denies! We have tried billing as one line item with quantity listed as 2. Still Denied. The only thing that seems to work is if we combine the lens price and bill as one lens, but this strikes me as fraudulent. Please help!
 
They obviously have a problem in their software for processing those claims. If they can't or won't correct it, you may have to do what you're doing to get paid. I hate to tell people how to code incorrectly in order to get paid but, recently the actions of several insurers have just about made it impossible to get paid for services which were always p[roperly paid for in the past. Retinal photos or OCTs are all of a sudden "experimental" and Aetna had decided that pre authorizations were required for out patient cataract surgery.
It seems like anything they can do to delay payment for services properly rendered and properly billed is at the top of their agendas.

Tom Cheezum, OD, CPC, COPC
 
19bowers78 said:
Recently, Premera and now other companies as well have been denying the second lens as duplicate. We usually bill each lens separately and had zero issues for YEARS. All of a sudden Premera started denying the second eye. You call them and they reprocess, and it still denies! We have tried billing as one line item with quantity listed as 2. Still Denied. The only thing that seems to work is if we combine the lens price and bill as one lens, but this strikes me as fraudulent. Please help!
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I hold the 2d pair a day or so it will deny as maxed benefits that way.
 
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