I'm in Indiana and we're receiving denials from Ambetter stating G35 is an invalid primary diagnosis. We called Ambetter and were told the claims shouldn't have denied and they would put back through to be reprocessed. Claims again are denied for invalid primary diagnosis. Any suggestions?
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Wiki Multiple Sclerosis - G35 not valid primary diagnosis?
- Thread starter vcar
- Start date
mitchellde
True Blue
G35 is an acceptable fist listed diagnosis code. I have found a few electronic look up sites that indicate it must have an F02 or and F48 code listed first which is incorrect. So it sounds like they have an incorrect edit in their system.
When we received the 1st denial I researched and found exactly as you stated - 1 website indicated the code first notation. We requested Ambetter reference the actual ICD 10 book and they agreed the claim(s) shouldn't be denied but we can't seem to get them to fix the problem. UGH.
synergyrcm
New
We are also getting denials for G31.9 as a primary code...HELP!!!!