Wiki HORIZON BCBS OF NJ DENIALS ON INTITAL HOSPITAL VISITS

[surfergirl]

Hi all,
Would greatly appreciate feedback if anyone else is having this issue? This is happening quite often lately when my physician is "ATTENDING"

I have 3 denials from 3 different patients for 99223 stating "this service is not paid, the number of units billed is greater than the allowed/approved frequency limit"

When I call Horizon on this the rep's just tell me they will send back for reprocessing and still I get denials! Even if I down code I still get a denial!

Thank you

 

[iowagirl77]

Is it possible they want the AI modifier to be added for the attending/admitting provider? I don't have experience with Horizon, but I know some BCBS plans want this to be used. Otherwise check and see if another provider of the same specialty already billed the initial admit code the same day (or if the admit was billed another day by any provider specialty).