Tag: #deniedclaims

Posted in Insurance, Payers and CPT reinbursement

1199 payer and cpt code 95012

Posted on by KR2Medical Billing

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.

Posted in Insurance

Does your office accept BCBS exchange patients?

Posted on by KR2Medical Billing

When the new healthcare reform took place so did the increase in more plans and networks that the payers, like BCBS started to offer to the members. Great! More people are covered and providers are able to see more patients.

However, the problem that the providers are running in is the fact that these plans have their own network. One of these networks is Pathway x Enhanced, offered by BCBS to the members that buy the insurance on exchange website.

Why is this a problem for the providers? Simple, Pathway X Enhanced network is exclusive to only certain Paycard%20300%20200providers that were selected for that network by the BCBS its self. But I am INN with my Local BCBS, can I join the Pathway X Enhanced network too? Unfortunately the answer to that question is NO. Why? Simply put there is a certain criteria that provider needs to meet in order to be in the Pathway X Enhanced network. You could also request the very complicated explanation from BCBS but if you have not received it in the early 2014. LOL

To avoid rejected/denied claims: train your front staff to recognize which patients have this particular coverage and double check the benefits for incoming patients BEFORE they come to the office-making sure that the incoming new patients have OON benefits and you are not incurring charges that you will have a hard time collecting.