Hello! I am fairly new doing the billing for home healthcare services. Our claims starting from 2021 billed to Anthem Mediblue HMO's and/or PPO's plan are being denied. The denial reason is they are requesting us to submit the new claim with correct billing form per CMS home health guidelines.
We are considered as a facility, we are submitting the claims on a UB04 CMS claim form, we cannot submit it on a CMS 1500 form. And the claims are submitted electronically via our clearing house to Anthem BCBS.
According to the signed contract, Anthem BCBS is to reimburse the home healthcare services: RN, PT, OT, Speech Therapy, Medical Social Worker service, and home health aide services at a per visit rate.
The claims are billed with type of bill: if first bill as 322, interim bill as 323 and last bill as 324, the stat status code 30 if patient is still active receiving HHC services, 01 if patient the is discharged or stopped receiving the service, plus billed with the appropriate HIPPS code, which is as per CMS guidelines.
When contacted Anthem to inquire on the denials, they were not helpful in explaining how to fix the issue. We also tried to reach out to our provider relation representative and there is no feedback from there either.
I really need some insight or help understanding why our claims are being denied for the above reason, please help!
My email address: pgujar@waveny.org
Thank you,
Pooja Gujar
We are considered as a facility, we are submitting the claims on a UB04 CMS claim form, we cannot submit it on a CMS 1500 form. And the claims are submitted electronically via our clearing house to Anthem BCBS.
According to the signed contract, Anthem BCBS is to reimburse the home healthcare services: RN, PT, OT, Speech Therapy, Medical Social Worker service, and home health aide services at a per visit rate.
The claims are billed with type of bill: if first bill as 322, interim bill as 323 and last bill as 324, the stat status code 30 if patient is still active receiving HHC services, 01 if patient the is discharged or stopped receiving the service, plus billed with the appropriate HIPPS code, which is as per CMS guidelines.
When contacted Anthem to inquire on the denials, they were not helpful in explaining how to fix the issue. We also tried to reach out to our provider relation representative and there is no feedback from there either.
I really need some insight or help understanding why our claims are being denied for the above reason, please help!
My email address: pgujar@waveny.org
Thank you,
Pooja Gujar