Wiki UHC Medicare Solutions denying PPD

[amywhit]

We are currently having an issue with UHC Medicare Solutions denying our claims for 86580 (PPD) with diagnosis code Z11.1. They are not dropping it to patient responsibility. They are telling us we must write it off. In conversations with them, they are saying we must get an ABN signed so that the balance drops to the patient. WHY?! Medicare is paying these claims! The advantage plans are supposed to be following Medicare guidelines. UHC states that the PPD is covered but not for screening, which is why we would need an ABN signed. Why else would you get a PPD?! It's to screen for tuberculosis. Isn't it always going to be screening? If you've been diagnosed with TB, there's no further need for a PPD.

Also, I'm curious if anyone else is getting these same denials from UHC but are getting paid by Medicare and other Medicare Advantage Plans. Humana MCR Advantage plans are paying our claims.

Thanks for any help you can offer!