Wiki E/M Codes being denied because NP cannot bill

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kpina613

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I am having a hard time with UHC denying 99213 and 99214 due to "the provider is not eligible to bill the procedure code for this service based on our reimbursement policies" The provider is a nurse practitioner, all other insurances are paying for them, and UHC is paying for most of them billed by the same provider but they are denying a handful of them. Any guidance would be great on how I can get these visits paid for. Thanks!
 
I would definitely give them a call and have customer service internally re-process the claim . Any time they are paying most of the claims but not a handful its usually just one of their stall tactics. Our NPs bill E/M codes there's nothing that says they cant. And if your not getting a satisfactory answer always ask for a supervisor.


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I just spoke with the other girl who does AR and she handles UHC. She said we are coming across this randomly also. She said make sure your Billing and supervising provider is the MD in the office and then put the NP as the rendering.
She said for these handful of denied claims when she changed this theses claims got paid.
Hope this helps
 
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