Effective September 10, 2019, Horizon BCBSN will change the way consider certain professional claims for services provided to Horizon BCBSNJ Medicare Advantage (MA) members based on an update to our medical policy, Allergy Testing.
Based on the submitted diagnosis code(s), claims submitted for services provided on and after September 10, 2019 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.
The services represented by CPT code 86003 may be denied as not medically necessary.
Information may be requested to help us determine the medical appropriateness of the services represented by CPT code 86003. Following our review of medical record information, these services may be denied as not medically necessary.
Source: https://www.horizonblue.com/providers/news/news-legal-notices/medical-policy-update-allergy-testing-0
Blogger Widget
Popular Posts
-
Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...
-
An OPPS payment status indicator is assigned to every HCPCS code. The status indicator identifies whether the service described by the H...
-
Therapeutic activities are considered medically necessary for patients needing a broad range of rehabilitative techniques that involve ...
-
This procedure is medically necessary only when it requires the professional skills of a therapist, is designed to address specific ne...
-
HCPCS Modifiers: MA Ordering professional is not required to consult a clinical decision support mechanism due to service being rend...
-
CIGNA will adopt a common time frame for health care professionals to follow for submitting claims to CIGNA. Except where state law requir...
-
Urgent Care Centers are the Facilities that delivers Outpatient Medical Care usually for the conditions that does not require Hospital a...
-
CIGNA covers chiropractic manipulation and adjunct therapeutic procedures/modalities (e.g., mobilization, therapeutic exercise, traction) ...
-
Definition: The “-59” modifier is used to indicate a distinct procedural service. The physician may need to indicate that a procedure or...
-
Health benefit payers, including Medicare, are limited to use of those internal and external code sets identified in the implementation gui...
