miclana89
New
We have had quite a few denials from WellCare for CABG procedure due to an evaluation and management code missing a modifier, the EM was performed by a provider of a different specialty. We have appealed multiple times and have taken up to the provider relations department. The only thing they keep saying is that bc their claim edit shows paid, we coded it incorrectly.
We have provided them the global surgery package booklet and have provided examples from CMS and AMA that prove they are wrong in their determination of denying a major surgical procedure due to paying an EM claim that was not appended to the modifier.
Has anyone else had the same issue and were successful in overturning?
We have provided them the global surgery package booklet and have provided examples from CMS and AMA that prove they are wrong in their determination of denying a major surgical procedure due to paying an EM claim that was not appended to the modifier.
Has anyone else had the same issue and were successful in overturning?