H0032

What I use is code H0032 UA UD and we had not had problems with that code.

We use the UA and UD modifier as well with no problems

Updated question to this issue . . . .

If client has private primary, then PMAP, how is everyone billing this code?  We are having a difficult time with both PrefOne and BCBS paying or denying this code with a PR so we can send to secondary PMAP insurer.

In addition, we are also having issues with Blue Plus paying this code in general, seems to be hit and miss.  Anyone else having this issue?

We have issues with PreferredOne denying ANY codes as PR, so we may in turn send to the secondary payer. 

It took 10 months for them to agree to change how they are denying for us, and I am currently waiting for them to contact me regarding their system being updated to now deny all of our claims as PR and not CO. They said to give them until after the holidays, so I'm guessing after January 1 I will FINALLY be able to get claims denied correctly by them. 

Our Contract Manager is Jason Roys, and he is impossible to deal with on any issue. I had to go through DHS and the AUC and file an SBAR to get him to budge. The AUC and DHS are currently working on getting other payers to deny without the CO, as well. I haven't heard anything on the process in the last two weeks, but plan to follow up with my DHS contact this week.

Jason Roys is our contact as well and has been incredibly helpful.  I'm sorry you are having so many issues. 

I am confused by the comment about "getting other payers to deny without the CO"  If you are contracted with the insurance company, the CO 45 and the PR  are both required on the COB tab when submitting to secondary. 

If I understand right, when certain services are NOT covered by the primary payer, there should only be 1 denial reason code (CARC) and the full billed amount for the code, usually there is not a CO 45 (although, I think I have seen this with Preferred).  So sarah is looking for a denial with PR and not CO to send onto the secondary. Right?

Correct. Our Contract Manager (Jason) told me I had to speak with claims, and get them to deny differently. They (claims) told me I had to get our contract changed and transferred me to Jason. Jason told me I had to file a SBAR with the AUC. I did that, and DHS got involved, too. I think I have resolution, but it just has not be implemented, yet.

sarah, What is a SBAR?

Do you have a reference for that requirement? We are only getting CO denials, and it is causing great difficulty for us.

Is the insurance company discounting the entire amount or just a portion of the billed amount?

They are not discounting anything. Some are rejecting at the clearinghouse, so then we don't even have a denial to appeal.

According to google:  SBAR is an acronym for Situation, Background, Assessment, Recommendation; a technique that can be used to facilitate prompt and appropriate communication. This communication model has gained popularity in healthcare settings, especially amongst professions such as physicians and nursing.