Wiki Different Specialty being bundled

[duplicatesandra]

Is anyone having trouble getting their claims paid when there are two different specialty's seeing the patient on the same day?
Example: My OB/GYN saw a patient for a WWE, and then the patient went and had a allergy shot done by the allergist on the same day. The insurance company(Aetna) is bundling the WWE (99396) into the allergy shot (95117).

 

[tpontillo]

You need to call the insurance and let them know that this is for two different specialties. Also If the allergist is not in your group then it would be two different tax ID's being billed. They should reprocess the claim over the phone

 

[duplicatesandra]

Yes, I did call the insurance and explained that this was two different specialist, same tax ID, but they would not reprocess the claim due to the insurance company just kept telling me that per their edits (the McKesson edits) the two procedures bundle into each other. I told the lady from the insurance company I understood that, but the McKesson edits does not allow you to put in specialty's. I got no where.