bar2ty@yahoo.com
Networker
Clover Health of NJ is denying all our claims for LCD L35049, A57361 for the diagnosis is inconsistent with the procedure. The procedure cpt code is 00731/AA-upper gastro endoscopic. The diagnoses listed in this order is Z87.19, K25.9, i10, Z87.891. I have disputed this, but Clover is still denying for LCD. My first concern is that LCD A57361 pertains to a MAC but this was a General anes. My next concern is should the order of dx be changed. We have over 400 claims denied for the same reason-LCD L35049, A57361-in some cases a MAC was performed and there is a dx code listed on the claim that is on the LCD list, but they are still denying for LCD. I have tried repeatedly to speak with a supervisor to no avail, and claims was escalated to their claims team, but no changes or response. Is anyone familiar with anes billing Clover Health of NJ?