H2019 U1 and H2019 U1 HQ denying PR 96 or CO 45 from Aetna and BCBS PMAP for 2017 DOS

crystalp 7 years ago in Billing/Electronic Modules updated by Laura Hulsey 7 years ago 7

Anyone else having all of your H2019 U1 and H2019 U1 HQ (DBT codes) denying from Aetna or BCBS PMAP for DOS in 2017? Aetna is denying CO 45 because the system is not recognizing the modifiers of U1 and U1 HQ. Similiar issue with BCBS PMAP, their new claims system is not reading the modifiers, so they are denying CO 96 bc they think it's a hospital visit. This impacts our clinic in a huge way. If you're having the same issues, please contact your BCBS rep and let them know so they will understand how big of an impact this is. We don't really have an Aetna rep, so I have no one to communicate this with, except calling to get the claims reprocessed, which I should not have to do!

Yes, we are experiencing the same issue-all BCBS claims are denying H codes with 96. I have notified our contact at BCBS. They had same issue last year, and it took claims dept 6 months to correct. I have been instructed to send a spreadsheet with denied claim info (ID, claim# or dos billed) to the BCBS Correspondence Team, ATTN: 804. Fax: 651-662-7364

Laura, have you sent in the spreadsheet with your denials? Have they paid them yet? Just curious as our claims are still not paying and we are in contact with Larry P at BCBS on a weekly basis. His most current response was something about DBT and CTSS, which are unrelated and if they think H codes are CTSS, then we know that is why their system is denying them.

Anyone else getting denials (Contractual Obligations 96) from BCBS PMAP for H2019 U1 and H2019 U1 HQ for DOS in 2017?

We are getting the denials, too. They are saying the code is not age-appropriate. They are reading it as the adolescent code. I had to submit appeals, after an hour on the phone with a customer service rep who would NOT transfer me to a manager. This is a HUGE amount of revenue for us, and BCBS was not helpful at all. I told the rep I didn't appreciate that I had to submit three appeals (three separate clients) because of their processing error. He asked if I needed help with anything else, and I told him he hadn't helped me with what I called about. How do I find out who our contact is at BCBS? Every time I call there, I get the automated system, and no help at all. Thank you for posting this issue!

We've been in contact with Larry Peyton since the end of January trying to get this resolved.

We have approximately 50 clients affected.

I'm sure he'll be happy to help you too...

Larry's contact info:

Larry Payton
Network Management Consultant
Phone 651-662-0995 | Fax 651-662-0659


Thank you! I so appreciate this information!

I have not sent in a spreadsheet for 2017 services, but sent a spreadsheet for 2016 services directly to Larry, and are still waiting on payment (for services over a year). BCBS started paying H codes in March, I thought the issue was resolved, but they are now denying again. Larry has told me repeatedly it is a claims system issue that their IT department is working on.