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Amerigroup denying deliveries/c-sections with U1 modifier

  1. Default Amerigroup denying deliveries/c-sections with U1 modifier
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    We are having an issue with Amerigroup, Texas denying our deliveries and C-sections when billed with a U1 modifier. Pt's are prior to 39 weeks and have "medically necessary" issues including Pre-Eclapmsia. Is anyone else having this type of problem? All I find when I goggle is an ariticle from 2015 that has ICD9 diagnosis on it and our diagnosis cross to the ICD9 codes.

  2. Default Amerigroup denying deliveries
    Have you called and spoken to a rep for the reason of denial? Is there an authorization number for the hospital admission? Assuming that it was a clean claim with all the i's dotted and t's crossed according to the carriers instructions, there are just some companies that are more notorious than others in denying claims at first submission. A phone call is needed to show them that everything is correct and they should pay the claim. Another 30 days for the physician to collect. If you are noticing a pattern here and, again everything is correct on your end, I would first contact the provider rep at the insurance company to lodge a complaint and then contact the Texas Department of Insurance. I believe they regulate HMOs and Amerigroup is an HMO.

  3. #3
    Location
    Chattanooga, TN
    Posts
    44
    Default Amerigroup
    We, too, struggle with getting Amerigroup to pay here in Georgia for patient deliveries prior to 39 weeks. Especially spontaneous deliveries! Provider Rep has tried and has had some success, but it can be a real issue getting payment. Pull Joint Commission information for Perinatal Core Measures ICD-10 Code Exclusions Table Number 11.07 to see if any diagnosis codes on their list fit your case. I have used this in the past to appeal and have been paid. Good luck!

  4. Default Amerigroup Denials
    Hello!
    I am having the same issue, we are following the criteria and still receiving denials in a different state. I am reaching out to the provider rep in hopes she can assist me, or I am going to have to esclate the issue.

  5. Default
    Quote Originally Posted by kgatson View Post
    We are having an issue with Amerigroup, Texas denying our deliveries and C-sections when billed with a U1 modifier. Pt's are prior to 39 weeks and have "medically necessary" issues including Pre-Eclapmsia. Is anyone else having this type of problem? All I find when I goggle is an ariticle from 2015 that has ICD9 diagnosis on it and our diagnosis cross to the ICD9 codes.
    Have you had any luck?

  6. Default
    I'm from NY and we have had the same issue with BCBS Healthplus (amerigroup). Prior to 39 weeks we use modifier U8. If patient delivers prior to 39 weeks with medical necessity we use modifier U7. BCBS Healthplus (amerigroup) also requires us to prior the delivery outcome and gestational weeks for diagnosis with the correct modifier for us to receive reimbursement. I also bill for NJ and they only require the delivery outcome and gestational week along with the type of delivery. Example FOR NY: 40 week pt, NSVD, female infant live.
    59400-U9
    O80
    Z37.0
    Z3A.40
    NJ Amerigroup will be the same just without modifier

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