robertjsenese
Guest
I'm receiving claims come back from commercial payers (primarily blue and Humana) that state "non-covered charge" however there is an authorization number on file for CD-IOP sessions.
I've been told by claims reps H0015 is a "non-hipaa compliant code" which doesn't make sense to me since its its created by CMS/hcpcs.
I've been told by claims reps H0015 "is not a commercial covered code"- which would make sense if there was a CPT code for IOP)and to "bill the claim without the H0015." But then you attempt to bill with just the rev 906 and the claim is denied for not having a service code.
Humana seems to love doing this lately for an authorized Php treatment, when billing 912/s0201.
If let's say Humana one ACA policies are saying its non-covered, but previously authorizing treatment days to a non-par, then it should be stated in the VOB that it's a non-covered service. But when a VOB is done, and S0201 is asked if it is covered, they say yes.
Anyone else running into this issue?
I've been told by claims reps H0015 is a "non-hipaa compliant code" which doesn't make sense to me since its its created by CMS/hcpcs.
I've been told by claims reps H0015 "is not a commercial covered code"- which would make sense if there was a CPT code for IOP)and to "bill the claim without the H0015." But then you attempt to bill with just the rev 906 and the claim is denied for not having a service code.
Humana seems to love doing this lately for an authorized Php treatment, when billing 912/s0201.
If let's say Humana one ACA policies are saying its non-covered, but previously authorizing treatment days to a non-par, then it should be stated in the VOB that it's a non-covered service. But when a VOB is done, and S0201 is asked if it is covered, they say yes.
Anyone else running into this issue?
