Wiki Humana denials

[pattiland]

We are having a problem getting Humana to pay for E/M exams with CMT. Anyone else having this problem?

First denial is almost always incorrect (ie. denying new patient exam when the patient is new or hasn't been seen in over 3 years) We include documentation and a paragraph on why the doctor sees medical necessity for an exam. The second denial is just based on medical necessity and then we get a massive request for notes on past and current treatment. We don't see anything in our contract about bundling E/M with CMTs like United Health Care does.

We don't have many Humana commercial patients, but this is getting so annoying that we may consider dropping out of Humana network.

Any ideas would be appreciated!
pattiland

 

[ejlehman]

Humana never paid exams for us. They always told us "they follow Medicare guidelines" for E/M.

 

[01289355]

Please review the attached pdf. May you get some idea

 

[pattiland]

Humana never paid exams for us. They always told us "they follow Medicare guidelines" for E/M.

Thank you- that's what we figured, but can't find it in writing and when we call they won't tell us that.