Wiki Community First(Medicaid HMO)

[reyesjr]

Hi Fellow Coders,

I am reaching out to you all to find out if any of you might have received a Provider Newflash on New OB Delivery Claim Requirement for Community First as they are denying all delivery and postpartum claims.
Thank You,
Janie

 

[Anastasia]

I'm not familiar with that insurance but why are they denying the claims? Do they want the delivery only code billed with the visits billed separately?

 

[reyesjr]

ThanksI do coding for Inpatient hospital Vaginal & C/S deliveries. The claims are being denied because of CPT code that was selected which is either vaginal or cesarean including postpartum cpt codes 59410 & 59515.

 

[reyesjr]

Denials from Community First for Inpatient hospital Vaginal & C/S deliveris

Thanks Anastasia for responding...I do coding for Inpatient Hospital Vaginal & C/S deliveries. The claims are being denied because the CPT code that was selected for vaginal(59410) or cesarean(59515) includes postpartum. On the EOB denial the reason given is to use different CPT code. I have call several times to Community First(Medicaid HMO) claim department to get some clarification and have not found the answer why they are not paying the claims.

Thank you in advance,
Janie