yumi_leggs06
Contributor
Hi, everyone.
I have 15 denial Medicare AWV claims from BCBSNC Medicare Advantage HMO/PPO since this January. The denial reason is THE DIAGNOSIS IS INCONSISTENT WITH THE PROCEDURE. Our claims were submitted with any dx that were brought up/discussed between provider and patients during the visit. I called BCBS MA customer service many times but that they did not help me at all. They told me to do corrected claim but there is no correction I need to make in our claims. Medicare guidelines states that there is no specific dx code for AWV. Even BCBSNC MA guideline does not state about anything related to specific code to use for AWV. I have filed provider appeals but it turned out they dismissed my appeals because it is not appealable. Has anyone or practice come across the denial claims like this by BCBSNC MA? I have never had a bulk of denial claims of AWV from one commercial Medicare Advantage.
I have 15 denial Medicare AWV claims from BCBSNC Medicare Advantage HMO/PPO since this January. The denial reason is THE DIAGNOSIS IS INCONSISTENT WITH THE PROCEDURE. Our claims were submitted with any dx that were brought up/discussed between provider and patients during the visit. I called BCBS MA customer service many times but that they did not help me at all. They told me to do corrected claim but there is no correction I need to make in our claims. Medicare guidelines states that there is no specific dx code for AWV. Even BCBSNC MA guideline does not state about anything related to specific code to use for AWV. I have filed provider appeals but it turned out they dismissed my appeals because it is not appealable. Has anyone or practice come across the denial claims like this by BCBSNC MA? I have never had a bulk of denial claims of AWV from one commercial Medicare Advantage.