Wiki H-Codes Denied

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kate.charette

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Hello!
We are a free-standing facility that provides both in and out patient services. We got an authorization for Residential Tx from BCBS Nebraska for a patient who has out of network substance abuse benefits. However, the claim was denied. When we called to follow up, the BCBS rep told us that the claim was denied due to the H-code (H0010). When pressed, the rep told us that all H-codes would be denied for all levels of care - even though we have an auth and the patient has benefits.

Has anyone run into this before? How have you gotten around this? Usually when we call and tell the rep we have an auth, they submit the claim for pricing and payment. BCBS Nebraska won't seem to do it.

Thank you in advance!
Kate Charette, CPC
 
kate.charette said:
Hello!
We are a free-standing facility that provides both in and out patient services. We got an authorization for Residential Tx from BCBS Nebraska for a patient who has out of network substance abuse benefits. However, the claim was denied. When we called to follow up, the BCBS rep told us that the claim was denied due to the H-code (H0010). When pressed, the rep told us that all H-codes would be denied for all levels of care - even though we have an auth and the patient has benefits.

Has anyone run into this before? How have you gotten around this? Usually when we call and tell the rep we have an auth, they submit the claim for pricing and payment. BCBS Nebraska won't seem to do it.

Thank you in advance!
Kate Charette, CPC
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It's my understanding all H codes are used by Medicaid state agencies. We've never billed this to a commercial carrier. Have you had success with other commercial plans?
 
Most home plans will accept H0010/H0015 etc for BCBS
some won't however, did you try billing with just the REV code and the auth?

If you are calling and a rep is resubmitting the claims for you for pricing and payment, the rep is probably deleting the H0010 and resubmitting the claims.

Call and do a VOB, see if hcpcs H0010 is covered, if not, you need to submit with just the REV and authorization number.
 
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