KMCFADYEN
Expert
My claim was billed as:
99205 25
98926
We were paid for 98926 and 99205 was denied as bundled. we called first to question this denial and the rep sent it back for reprocess stating the claims department must have missed the modifier 25. It denied as bundled again. we then sent in a written appeal. we have now been denied with Cigna stating the original denial is upheld AND our appeals are exhausted?
I inquired if Cigna would allow 99201-99204 with modifier 25 and CPT 98926 and they will.
The only conclusion I can come up with is that there is an internal edit error which I have run into before with other insurance companies. While it took the Provider reps time to correct the error, they were eventually corrected.
No one I spoke with at Cigna even understood what I was saying. They either restated that my appeals have been exhausted or that I needed to speak to some other department.
I am wondering if anyone has a suggestion as to how to get an internal Cigna edit error corrected. I have found that Cigna has an edit in place for new patient E&M CPT 99205. I have been given the run around by every department (customer service for claims, provider relations, credentialing-I did not ask for them, and a supervisor in customer service for claims-sounded exactly like the previous person I spoke to) I have spoke to at Cigna. The biggest problem is that they do not have provider reps-they are all internal and you have to call the main number to get transferred to provider relations (after you have provided your EIN, NPI, patient ID, patient DOB, etc. at least two times!).
99205 25
98926
We were paid for 98926 and 99205 was denied as bundled. we called first to question this denial and the rep sent it back for reprocess stating the claims department must have missed the modifier 25. It denied as bundled again. we then sent in a written appeal. we have now been denied with Cigna stating the original denial is upheld AND our appeals are exhausted?
I inquired if Cigna would allow 99201-99204 with modifier 25 and CPT 98926 and they will.
The only conclusion I can come up with is that there is an internal edit error which I have run into before with other insurance companies. While it took the Provider reps time to correct the error, they were eventually corrected.
No one I spoke with at Cigna even understood what I was saying. They either restated that my appeals have been exhausted or that I needed to speak to some other department.
I am wondering if anyone has a suggestion as to how to get an internal Cigna edit error corrected. I have found that Cigna has an edit in place for new patient E&M CPT 99205. I have been given the run around by every department (customer service for claims, provider relations, credentialing-I did not ask for them, and a supervisor in customer service for claims-sounded exactly like the previous person I spoke to) I have spoke to at Cigna. The biggest problem is that they do not have provider reps-they are all internal and you have to call the main number to get transferred to provider relations (after you have provided your EIN, NPI, patient ID, patient DOB, etc. at least two times!).