Wiki Anthem Denials for Mental Health

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vgriffin

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I am getting a lot of denials from Anthem for patients that have Anxiety, Insomnia and Depression stating that I need to bill Carelon. We are not providers with Carelon and they state they are for Mental Health providers and this is a PCP practice. Many of these patients are sent to our office because not all MH providers can prescribe medications. I am curious how other practices are dealing with this issue. Thanks for any input.
 
Navigating the complexities of Mental Health billing can be quite the adventure. It appears that the Anthem plan has specific provisions for Mental Health services. You should check the back of the insurance card; Mental Health/Behavioral Health services are directed to Carelon (formerly Beacon Health). Codes starting with 'F' in the ICD-10 are designated for Mental Health, which is why they trigger the claim as such. For Insomnia, if you're using a 'G' code, submit it as the primary code to Anthem for payment.

I trust this information is beneficial to you.
 
taylorjr said:
Navigating the complexities of Mental Health billing can be quite the adventure. It appears that the Anthem plan has specific provisions for Mental Health services. You should check the back of the insurance card; Mental Health/Behavioral Health services are directed to Carelon (formerly Beacon Health). Codes starting with 'F' in the ICD-10 are designated for Mental Health, which is why they trigger the claim as such. For Insomnia, if you're using a 'G' code, submit it as the primary code to Anthem for payment.

I trust this information is beneficial to you.
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Thank you for the reply. It appears to be for the TPA plans specifically companies like Chevron and PG&E. That is what makes it so confusing.
 
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