Reimbursement for Drugs used for IT pump re-fill.

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We have difficulties with reimbursement for drugs uses for IT pump re-fill with Humana and UHC commercial.

1.Humana Medicare.
Denies all J codes reported (we bill following Medicare rules we are in TX), by stating that DX are inconsistent with procedure. We file all claims by paper attaching all relevant medical records and other supporting documentation that provides detailed explanations on reporting and reimbursement for such services; but Humana still denies J codes. Then we send the same record package as reconsideration request and it literally takes about 2-3 month to get Humana those services processed and paid.

2.UHC commercial.
Since there are no UHC guidelines on reporting J codes for IT re-fill we report each code individually with corresponding NDC. We did not find any policy on UHC website, we spoke to UHC and they could not provide us with their specific guidelines on reporting drugs used for IT pump re-fill. .
We utilize Noridian Crosswalk to match HCPCS –NDC.
UHC pays, but latter takes money back by stating that HCPCS –NDC combination is invalid.
We tried to report such drugs utilizing Medicare guidelines as report J7999, but services were denied by stating that the service is not a benefit.
We tried to report such drugs with J3490, but services were denied by stating that the service is not a benefit.

I would appreciate any help on listed above issues.
 
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