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Anthem Coding Problem Fix

10 Jun 2021 2:36 PM | Paul Gaspar (Administrator)

Hello members-

As you may know, many CA are experiencing improper denials from Anthem.

The 2 reasons for denials have been:

1. Issues getting the Excludes 1 dx denials denied as duplicates when resubmitted electronically as replacement claims

2. Incorrect NCCI edit denials for modifiers

To get paid by Anthem for improperly denied claims, please return the attached spreadsheet (red link below) to Liz Souza, DPT, CHT:

lsouza@gmspt.com

Please click on the red link and fill out the spreadsheet in the following manner:

Provider Escalation Claim Template.xlsx

  • Provide 5-10 claim examples of each situation for each employer tax ID number. Once they establish the issue, they will do a claims sweep for that tax ID.  So no need to include all claims.  
  • Create a separate tab on the Excel sheet for Excludes 1 dx. and Modifier Denials
  • Create a third tab with any claims processed correctly with the same code pairings so they can compare.

At your service!

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