Wiki Drug code J0178 being denied for not being billed on the same claim form with 67028.

[eceped01]

Humana denied for not having 67028 billed together on the same claim form with drug code J0178. We do a correction by adding the J0178 to the same claim form where 67028 was billed. Then, Humana come back denying for the same reason.

Have you guys experience this issue? Do you guys appeal? ( I have appeal this denial and I still get a response stating "First decision stands".

 

[mgleason7]

We are having this same issue and appeals are not working for us either. It is every.single. J0178. And I have queried Humana through Availity and still cannot get an answer.

 

[mgleason7]

Humana denied for not having 67028 billed together on the same claim form with drug code J0178. We do a correction by adding the J0178 to the same claim form where 67028 was billed. Then, Humana come back denying for the same reason.

Have you guys experience this issue? Do you guys appeal? ( I have appeal this denial and I still get a response stating "First decision stands".

I got a response from Humana finally a few weeks ago that it was a known issue in their system and they were reworking affected claims via IPAR but to date, we are still getting denials for the same issue. The hospital system I work for is pending a joint operations committee meeting to discuss the issue with Humana and get to the bottom of it.