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Wiki Humana Denial

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astumler98

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Is anyone having trouble with Humana not paying office visits, even with a mod 25 attached? These are all being denied in our office and bundled with lab services or vaccines. Does anyone have any thoughts are how to correct?
 
Are you appending modifier 25 to E/M codes reported on the same date as vaccine administration codes (90460-90461, 90471-90474)? There are CCI bundling edits for vaccine administration codes with problem-oriented and preventive E/M services. Not sure about denial of E/M with labs. Hope that helps.
 
jh1991

Not just OVs but other codes. I have one claim seeing a hospice patient for non hospice treatment (Humana Medicare Advantage). Filed with Medicare 1st then with Humana for co-insurance. Medicare said Humana should pay but they keep refusing, telling me to file with Medicare. Have sent all information and a letter. Same reply.
 
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