med management denials with Aetna

crystalp 7 years ago in Billing/Electronic Modules updated 7 years ago 2

Has anyone else experienced consistent denials with Aetna for med mgt codes: ie 99213, 99214, & 99215 for various reasons including no authorization, no referral or provider type cannot bill this procedure? Every time we call to see exactly why it denied, we get different answers. I've spend 1 hour today, trying to get to the bottom of it and I still don't know if I'm clear with what we need. Some reps say the plan needs a PCP referral, another rep says we need pre-auth, pre-cert dept says it's not needed for mental health, some say add modifier 25, etc... help!

We have only billed a handful of these codes to Aetna and one did deny for 'provider cannot bill this specialty type'. When we called to see if it was something in the client's policy, we were informed that the reason it denied was because our CNS was set up in their system as a clinical social worker and not a clinical nurse specialist. They supposedly fixed it in their system and were going to reprocess the claim, but nothing has come back through yet.

Yes, our CNP was set up in their system wrong too, as a LPC or something.