jebond123
Contributor
My doc followed a patient for her entire pregnancy, including 11 prenatal visits, c-sect delivery, and postpartum follow-up. Global billing (59510) was submitted and paid with date of service 6/28/22. During her pregnancy, a covering doc saw the patient once while my doc was on vacation. His biller submitted 59425 in error & insurance paid him. Subsequently, Anthem has requested a full refund of our claim. I submitted a provider dispute form with a copy of her flow sheet showing visits as well as a detailed explanation of what happened. Also, other doc's biller sent a "letter requesting claim be voided" but that is as far as she will take this. Anthem states they never received void request & review of our records was found to be insufficient. They have retracted our claim's payment. I am left now with the only option of submitting corrected claim to get some portion of this back. My question is this: how do I send a claim for the antepartum visits as a corrected claim if we never submitted one to begin with? I am sending 59515 to replace 59510 for the delivery portion on the original claim (as corrected) but the antepartum visits(59426) have never been billed out so won't they deny this as beyond the billing deadline? I am not sure if it is possible to include the antepartum visits on the same claim as the in-patient delivery claim. Please help me - Any input is very much appreciated.
Janet
Janet