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Aetna requesting medical documentation.
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Re: Aetna requesting medical documentation.
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jaym29
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Oct 19 10 10:20 AM
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My Recent Posts
Steve,
I have another question same insurance company. With the guidelines they have in place for back pain- invasive procedures. Back in December we were advised that the policy for the facet injections would be changing and this would be implemented on 5/14/2010. But the clinical policy still shows that the policy became effective on 7/31/1995, however the change was implemented on 5/14/2010. So here is my question, a patient had a facet injection in September which counted as 3, as patient is allowed a total of 6 per each procedure. This is the first injection the patient had for a facet in 2010 and since the implementation date of 5/14/2010. The claim denied for experimental and investigational. I called Aetna in reference to this and was advised the patient has already had this procedure twice and this was the third therefore it was denied. When I requested to find out by whom she had the other 2 procedures done by I was advised of the dates of service for 2 claims billed by my office back in 2009. When I advised the represenative that this (new policy change) was implemented on 5/14/2010 I was told that the policy has been effective since 7/31/1995. I am quite confused by this, and not sure how to understand the policy and the change. Am I not reading something correct? HELP!!
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Association News
Medical Billing & Coding Education from the MAB
Continuing Education
Management Advice and Training
Questions Asked More Than Once
Help Wanted - Billing and Coding
Non Billing Talk
The Venting Area (Clean posts please)
Medical Coding and Billing News
Fraud and Abuse
Health Insurance - Provider Contracting
ERISA
Tricare
Workers' Compensation
General Medical Billing Questions
Appeals
Accounts Receivables (A/R)
Refunds
Auto Accident Issues
Medisoft Technical Support
Medical Software Technical Support Questions Other than Medisoft. No Investigation Questions!
General Medical Coding Forum
CPT Coding Questions
HCPCS Coding Questions
ICD-9-CM Coding Questions
Evaluation & Management Coding Questions
Acupuncture Billing and Coding
Ambulance Coding and Billing
Cardiology Coding and Billing
Chiropractic Coding and Billing
Dental Billing and Coding
DME Coding and Billing
Emergency Department Coding and Billing
Family Practice Coding and Billing
Hospital Inpatient and Outpatient Coding
Hospital Billing, Appeals and Collections
Internal Medicine Coding and Billing
Laboratory Coding and Billing
Ophthalmology Coding and Billing
OB-GYN Coding and Billing
Pain Management Coding and Billing
Pediatric Coding and Billing
Podiatry Coding and Billing
Physical Therapy Coding and Billing
Psychiatry Coding and Billing
Radiology Coding and Billing
Surgery Coding and Billing
Neurology Coding and Billing
Urgent Care Coding and Billing
Provider Compliance
Billing Center Compliance
HIPAA
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Pain Management Coding and Billing
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Aetna requesting medical documentation.
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