Claim Rejected. Insurance has been filed for years for this client and its claiming the CPT code is incorrect, yet that has been used for years.
Claim has been rejected only when there's an add on of time adding 99354 to 90837. I need help. It reads as follows: Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected. HCPCS/CPT/CDT3 CODE (PROCEDURE CODE) INVALI (A7 - 21)
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Did your payer recently switch to using the Availity portal? I had a similar problem with one Magellan Medicaid plan that switched - previously I had no problems using the SP billing function, but after the switch I found that I had to go in to Availity and manually enter my claim. I never was able to find out why this occurred, but hopefully it will help you get paid. On a side note, I had to contact my payer multiple times before I received payment for those rejected claims. Hope your process is quicker!
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We work out of network, but file insurance for clients to make it easier for them to receive their reimbursement. We had this issue present itself years ago and were told this was the correct Code to file for this specific client/situation. Beginning this year, all of their Claims have been declined. I will look into the Availity and check with the client. Thank you.
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I think something changed as of January 1, 2023. I had add-on code 99354 accepted for client in December and rejected in January for the same client. And I’ve read Tricare stopped using this code as of this year also. Idk what to do though or where to find the official ruling from BCBS.
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