I have had zero luck so far. First they deny for records. You send records then they deny because the Dr didn't sign every page, even though our pages state electronically signed and CMS states that is valid. You fix that. Then they'll say, well the allergy mixing note didn't state that the Dr was in office and supervised the mixing of the vials. You fix that. Then they'll say you didn't include all of the manufacturer names, lot numbers and expiration dates for the antigens. Then you fix that. Then, they finally state that the mixing doesn't fall within their Aetna CPB and that it is not a covered service. That's when more of the silliness happens. Because you'll ask them to tell you what in the CPB you are violating and they cannot answer. You go round and round with claims rep and get no where. You pull up the CPB and see that nothing has been exceeded. You are then told to appeal the denial, but what are you appealing if you don't know the reason? You appeal, show them the CPB where nothing has been violated - valid billed quantities, valid billed amounts, valid and covered icd-10 codes. And the appeal will be denied. Then you ask why was the appeal denied and no one can answer it. --This has been my saga since September. I was finally able to with someone, about a week and a half ago, and she very helpful. She said that when a claim is denied, the processor is supposed to put on the claim what you are in violation of and where it can be found for the reps to see and tell the provider. This one particular claim, there was nothing available for them to see for the reason for the denial and the claim was "locked" so no one could manually override the decision made by the processor. She them pulled up the CPB herself, and could not find anything we were in violation of. She went back and forth with her supervisor, who then sent me to the appeal dispute department but they said it was a claims processing error and it needed to go back and be corrected (exactly what I've been saying for 6 months now!). So, this one claim, has gone back for internal review for incorrect processing. I told her it was just for 1 provider in the office and it was for all of his new starts. She said they'll pull his NPI and, supposedly, fix the other claims also.