Humana H-codes denying Medicaid Use Only

campglo

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Is anyone experiencing Humana denying H-codes as Medicaid Use Only? I have spoken to them and advised that this is recognized by commercial payors and they stated no they are taking a stand and not paying . Even though we have confirmation on a VOB stating on a recorded line that the h-code and description of level of care is payable and billable . They advised they just want the rev code on the claim. I found a law on CMS.gov that public and private health insurances must comply with the HCPS level II coding. Of course I am appealing it . I also spoke to Humana Supervisor and she stated they are getting their information from the Optum Coding book 2015 pg 69 which states H-codes are used by Medicaid agencies only . I emailed Optum the law stating they need to correct their book to state Medicaid and private health insurance. I received an email that they are looking into it .
 
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Humana h code denials

What law are you referring to? We are having the same problem with Humana and just recently Optum? Would really appreciate your help!
 

CodingKing

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I don't think there is any law requiring a payer to recognize the H codes. Just like the G codes for Medicare there is no requirement that payers accept them for commercial plans. I don't work for Humana but the payer I work for allows H codes but we also get facility claims all the time without CPT or HCPCS codes.
 

crichmond

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Same issue

I am experiencing the same issue. They are even trying to take back H-codes prior to them making a policy that H-codes will be considered Medicaid only. I have talked to several different reps at Humana, some said to submit T-Codes, which don't make sense because those are specific for Medicaid, and there is not a T-Code for RTC/PHP or IOP from what I can remember. They did publish something saying they'd no longer pay H-Codes though.

The last time I spoke with a rep they said it was an error on humana's side that they are correcting because all behavioral health providers have been effected. However, I have not seen any claims reprocess and that was several months ago.

Have any of you found a resolution for this?
 

julie@medexplus.com

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Humana H codes denials

I have had issues with this as well and found that I can resubmit corrected claims for IOP sessions with the S9480 code and get those reimbursed and/or off set the refund requests Humana issued for all our H0015 billing. I had multiple VOB's that apporved the H0015 code was billable, we had authorization for both 905 and 906 revenue codes, Humana payed all the claims and then started issuing refund requests. What a cluster f... on their part...I have submitted claims reconsiderations to have them review the information they gave us, sent appeals, with no response from them other than calls from the refund department. I have been dealing with this since April 2016 but started sending all H0015 claims back through hoping they would pay the S code and reverse the refund requests. It seems to be working. I am researching the other code to bill for PHP other than H0035 or H2036
 
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BCBS Behavioral Health

Good afternoon I am having issues with bcbs paying proper reimbursement for codes H2036 has anyone else had this issue? Facility Billing.
Thank you, Amanda
 
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