belindapearl
Networker
Is anyone else having issues with Medicaid Healthy Blue? We started having several of our E&M visits being denied for being in global. I appealed them, the appeal was denied stating they are following MOHealthnet guidelines on global. Well MOHealthnet guidelines is there is a 30 day global on any procedure reimbursing more than $75. So I contacted our Healthy Blue rep and my response was they are following the 30 day global, but they do not have to follow the $75 rule. So basically if you perform any procedure the patient is in a 30 day global. An example a new patient came in for an injection (20600) it only pays I think around $30, so we get paid for the injection, no E&M even though are new, then for the 2 week follow up we can not bill an E&M. They state they are following correct coding policies. I asked what policies but have not gotten a response.
I have never had an insurance to make up their own rules like this. I have emailed MOHealthnet rep, I don't think this is going to help much. We will have to stop taking Healthy Blue, because our office can not afford to see them.
Any suggestions?
I have never had an insurance to make up their own rules like this. I have emailed MOHealthnet rep, I don't think this is going to help much. We will have to stop taking Healthy Blue, because our office can not afford to see them.
Any suggestions?