pudge2465@yahoo.com
Contributor
Is anybody getting Humana Medicare Adv denials stating "THE ENCOUNTER DIAGNOSIS WAS NOT BILLED IN THE PRIMARY POSITION. "
We have several denials on this however it is only Humana denying, all other Medicare/Advantage Plans are paying.Is anybody getting Humana Medicare Adv denials stating "THE ENCOUNTER DIAGNOSIS WAS NOT BILLED IN THE PRIMARY POSITION. "
Us too! We will bill (for example) G0439 with Z00.00 linked to it and a 99214 with like I10, E11.22, N18.31, and it will pay the G0439 but deny 99214 for "PAYMENT IS NOT ALLOWED FOR THIS EXAMINATION BECAUSE THE ENCOUNTER DIAGNOSIS WAS NOT BILLED IN THE PRIMARY POSITION.". I am only seeing this with Humana Medicare Advantage and when I called they could not give me a policy or anything that changed just that they can send it back for review. But we have so many of these denials I can't imagine having to call on every single one.We have several denials on this however it is only Humana denying, all other Medicare/Advantage Plans are paying.
I have called twice and was once told that it was based on Humana policy so when I asked if she could refer me to the policy she said that she couldn't find it so she sent the claims back for review. Then the second time I called they told me to fax them a spreadsheet with the claims to be reprocessed but neither reps could tell me if this was a known issue that is being fixed or give me a policy to reference. As of now, my team has been submitting a reconsideration with records on the Availity portal. Hopefully this gets fixed soon... I do not agree with putting a Z00.- code on a regular office/outpatient e/m so hopefully this will get fixed soon.We are having all of the same problems you guys are having with this primary dx denial for Humana. Has anyone gotten some kind of clarification on this because I've tried to search their policy, I really can't find anything that relates to their denial.
Have you gotten any resolution on this? We are billing the AWV with a Z00.00 and a physical (993xx) z00.00. Most of the time they are getting paid but we are seeing several denials for the DX code and HUmana cant tell us why other than Missing incomplet or invalid DX.I have called twice and was once told that it was based on Humana policy so when I asked if she could refer me to the policy she said that she couldn't find it so she sent the claims back for review. Then the second time I called they told me to fax them a spreadsheet with the claims to be reprocessed but neither reps could tell me if this was a known issue that is being fixed or give me a policy to reference. As of now, my team has been submitting a reconsideration with records on the Availity portal. Hopefully this gets fixed soon... I do not agree with putting a Z00.- code on a regular office/outpatient e/m so hopefully this will get fixed soon.