Posted in Insurance

Announcement: NY Empire Plan Claim Submission for 2019 Services -April 29,2020

General: Please remember that UnitedHealthCare (claim administrator for NY Empire Plan) has a claim submission policy  of 120 days from the DOS (Date of Service). Empire Plan Secondary Claims also have a claim submission policy of 120 days from the date that Medicare or another insurance claim has processed the claim.

For Services performed  at the end of year 2019 have to be submitted on April 29,2020

Paper Claims Address: those providers that are unable to submit electronic claims have to send their claims to The Empire Plan, PO Box 1600, Kingston, NY 12402-1600

Reminder: When benefits are denied because of the claim being submitted late, the participating physician or health care professional MAY NOT BILL the patient for the charges on that claim.

Posted in Insurance, My services, Payers and CPT reinbursement, Training

Empire Plan(UHC) and CPT code 95004

This is a third installment in my Payers and CPT codes series.

In this installment we will look at the payer Empire Plan (Light Blue card). For this payer UHC is the third party administrator and handles all administrative duties.

Now I am sure you know that when you see a patient with this type of insurance, there is a $20 copay for the office visit. However, not many providers know that there is also another fee for another service, if that services is performed on the same date.

The following will help you to collect the correct amount of patient responsibility from the patient, on the day of services are rendered, and not wait until the claim is processed, which could be 14 or more days; thus increasing your cash flow and reduce your outstanding A/Rs.

In this scenario, you have a new patient coming in to see an allergist for an unspecified allergic reaction:

Code 1: 99204 or 99203 – NEW PATIENT Patient responsibility- $20


Ok, now the patient also has not taken any antihistamines in at least the last week and would like to do prick allergy testing , cpt code 2: 95004.

According to UHC, the third party administrator for this plan, 95004- is considered a separate (diagnostice) procedure if performed on the same day, therefore there is also an additional co payment of $20 that is attributed to the patient responsibility.

So, lets review- new patient code 99204 or 99203 w/25 ,a code 95004 for skin testing – patient copay $20 for the office visit and $20 for the prick allergy testing.

Since I already know this in advance, I have a separate form that I give to patients when they arrive to the office, BEFORE performing the procedure.

Giving the patients the option of either doing the prick testing or sending them for blood work (no additional fee when they on that day, if dont in the outside lab)

If you have any other further questions, please feel free to contact me via email or phone, listed on my about me page, or via my LINKEDIN account or my Facebook page.

Until next time!

Posted in Insurance, Payers and CPT reinbursement

1199 payer and cpt code 95012

Have a lot of asthma patients?…Then this post is for you.

CPT code for NIOX testing is 95012

NIOX is a common test that Pulmonologists and Allergists/Immunologists administer to Asthma patients.

However, the reimbursement for this code veries from payer to payer.

In this post we are lookong at 1199 which only pays for Two (2) 95012 codes, perfomed in a calendar year.

Do you have a lot of denials from 1199 for (limit met)?… check out how many of 95012 you performed for that patient, per calendar year.

If you have any other questions, about this payer or any other, please feel free to contact me for a free GAP Analysis- valid 9/1/2017 to 12/31/2017.