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Posted By angie on 05-07-2019, 11:56:56 in Ob-Gyn
we are finding some payers like BCBS stating prior approval is needed for bv panel. 87510 87660 87480. which seems really strange. we can not treat pt unless we run this test and find out if pt has infection and which kind. we appealed, but had no luck. pt did have candida on result. can we bill based on result of test even though we ordered test for symptoms . see attachment
Comments (8)
Posted By Melanie Witt on 05-09-2019, 17:27:02
No you have to reappeal and provide them with evidence that the test was positive for candida as they are stating the patient had no medical need for doing the testing. While this would hold if she did not have the infection, it was found, and so the test proved to be medically appropriate. Do not send in a corrected claim because at the time of the test, you did not know she had the condition and the reason for the denial is medical necessity which must be disproved by you before they will change their minds. I saw no evidence that you sent the test results into the payer with a letter from the physician in support of the tests.
Posted By Melanie Witt on 05-09-2019, 17:22:02
No you have to reappeal and provide them with evidence that the test was positive for candida as they are stating the patient had no medical need for doing the testing. While this would hold if she did not have the infection, it was found, and so the test proved to be medically appropriate. Do not send in a corrected claim because at the time of the test, you did not know she had the condition and the reason for the denial is medical necessity which must be disproved by you before they will change their minds. I saw no evidence that you sent the test results into the payer with a letter from the physician in support of the tests.
Posted By Melanie Witt on 05-09-2019, 17:16:47
No you have to reappeal and provide them with evidence that the test was positive for candida as they are stating the patient had no medical need for doing the testing. While this would hold if she did not have the infection, it was found, and so the test proved to be medically appropriate. Do not send in a corrected claim because at the time of the test, you did not know she had the condition and the reason for the denial is medical necessity which must be disproved by you before they will change their minds. I saw no evidence that you sent the test results into the payer with a letter from the physician in support of the tests.
Posted By Melanie Witt on 05-09-2019, 17:11:47
No you have to reappeal and provide them with evidence that the test was positive for candida as they are stating the patient had no medical need for doing the testing. While this would hold if she did not have the infection, it was found, and so the test proved to be medically appropriate. Do not send in a corrected claim because at the time of the test, you did not know she had the condition and the reason for the denial is medical necessity which must be disproved by you before they will change their minds. I saw no evidence that you sent the test results into the payer with a letter from the physician in support of the tests.
Posted By Melanie Witt on 05-09-2019, 17:06:47
No you have to reappeal and provide them with evidence that the test was positive for candida as they are stating the patient had no medical need for doing the testing. While this would hold if she did not have the infection, it was found, and so the test proved to be medically appropriate. Do not send in a corrected claim because at the time of the test, you did not know she had the condition and the reason for the denial is medical necessity which must be disproved by you before they will change their minds. I saw no evidence that you sent the test results into the payer with a letter from the physician in support of the tests.
Posted By Melanie Witt on 05-09-2019, 17:02:32
No you have to reappeal and provide them with evidence that the test was positive for candida as they are stating the patient had no medical need for doing the testing. While this would hold if she did not have the infection, it was found, and so the test proved to be medically appropriate. Do not send in a corrected claim because at the time of the test, you did not know she had the condition and the reason for the denial is medical necessity which must be disproved by you before they will change their minds. I saw no evidence that you sent the test results into the payer with a letter from the physician in support of the tests.
Posted By Melanie Witt on 05-09-2019, 16:57:32
No you have to reappeal and provide them with evidence that the test was positive for candida as they are stating the patient had no medical need for doing the testing. While this would hold if she did not have the infection, it was found, and so the test proved to be medically appropriate. Do not send in a corrected claim because at the time of the test, you did not know she had the condition and the reason for the denial is medical necessity which must be disproved by you before they will change their minds. I saw no evidence that you sent the test results into the payer with a letter from the physician in support of the tests.
Posted By Melanie Witt on 05-09-2019, 16:53:18
No you have to reappeal and provide them with evidence that the test was positive for candida as they are stating the patient had no medical need for doing the testing. While this would hold if she did not have the infection, it was found, and so the test proved to be medically appropriate. Do not send in a corrected claim because at the time of the test, you did not know she had the condition and the reason for the denial is medical necessity which must be disproved by you before they will change their minds. I saw no evidence that you sent the test results into the payer with a letter from the physician in support of the tests.
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