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GHI AND CPT DENIALS

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  • peppyauntie121
    ONE OF MY DOCS IS A PODIATRIST. LATELY, GHI HAS BEEN DENYING CLAIMS FOR PROCEDURE CODES AS BEING COSMETIC PROCEDURES...WHICH THEY ARE NOT. ISOLATING CPT CODE
    Message 1 of 2 , Sep 10, 2008
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      ONE OF MY DOCS IS A PODIATRIST. LATELY, GHI HAS BEEN DENYING CLAIMS FOR
      PROCEDURE CODES AS BEING "COSMETIC" PROCEDURES...WHICH THEY ARE NOT.
      ISOLATING CPT CODE TO PAIN AND/OR BLEEDING STILL DOES NOT PAY.
      BESIDES DROPPING TO PAPER AND SENDING CLAIM W/MEDICAL RECORDS, ANY
      SUGGESTIONS?
      ALSO, REGARDING CPT 11055/56/57 RT AND LT; GHI WILL NOT PAY FOR BOTH RT
      AND LEFT, JUST FOR ONE WHETHER WE BILL SEPARATELY RT AND LT, OR USE
      A -50 MODIFIER. ANY IDEAS? THEY USED TO PAY BOTH UNTIL A YEAR OR TWO
      AGO.
      GHI IS A TOUGH COOKIE...SEEMS I ALWAYS NEED TO SPEAK TO A REP ON
      THEIR "LUNCH HOUR".
    • Josie Mapp
      Go on their website, search for the claim and you will find a link to send them a message about the claim. Explain the situation and ask them if there is a
      Message 2 of 2 , Sep 11, 2008
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        Go on their website, search for the claim and you will find a link to send
        them a message about the claim. Explain the situation and ask them if there
        is a new regulation to tell you what it is and the effective date. If they
        are making an error, they will re-process. Believe it or not, I get better
        results from them through their website than by mail or phone. You don't
        spend any time on the phone.

        I currently have like 8 claims being reprocessed and it takes 7-10 business
        days.

        On Wed, Sep 10, 2008 at 10:15 PM, peppyauntie121
        <peppyauntie121@...>wrote:

        > ONE OF MY DOCS IS A PODIATRIST. LATELY, GHI HAS BEEN DENYING CLAIMS FOR
        > PROCEDURE CODES AS BEING "COSMETIC" PROCEDURES...WHICH THEY ARE NOT.
        > ISOLATING CPT CODE TO PAIN AND/OR BLEEDING STILL DOES NOT PAY.
        > BESIDES DROPPING TO PAPER AND SENDING CLAIM W/MEDICAL RECORDS, ANY
        > SUGGESTIONS?
        > ALSO, REGARDING CPT 11055/56/57 RT AND LT; GHI WILL NOT PAY FOR BOTH RT
        > AND LEFT, JUST FOR ONE WHETHER WE BILL SEPARATELY RT AND LT, OR USE
        > A -50 MODIFIER. ANY IDEAS? THEY USED TO PAY BOTH UNTIL A YEAR OR TWO
        > AGO.
        > GHI IS A TOUGH COOKIE...SEEMS I ALWAYS NEED TO SPEAK TO A REP ON
        > THEIR "LUNCH HOUR".
        >
        >
        >



        --
        Josie Mapp, Medical Biller & Collector
        JG Professional Services
        Cell: 917-892-7201

        DISCOUNT HEALTHCARE FOR PEOPLE WHO DO NOT QUALIFY FOR MEDICAID OR DO NOT
        HAVE EMPLOYEE BENEFITS:
        www.mybenefitsplus.com/40612305


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