Recent insurance denials ICD-10

[wendysmithey]

As some of you may know, many of the 2021 medicare advantage plans now have a built-in dental portion for the member.  This is different from the add-on dental plans that were offered in the past. 

We recently ran into a new type of denial because these claims are being processed by the medical division of these plans.  Our recent claims were with Humana Medicare, the patients routine exam and cleaning visit   D0120, and D1110 were kicked back for want of a ICD-10 diagnosis code. 

Our office is not an In-Network provider with any insurance company, nor are we In-Network with Medicare, we did however years ago choose to be a referring and prescribing provider so that our patients could at least have prescriptions covered.  As more advantage plans offered out of network riders, we were able to help our patients utilize their dental plans.

I have no idea how we can offer the ICD-10 codes.  They do not populate in our code screens.

thanks

[mbusinelle]

We have always dealt with Humana and been a provider.  However, apparently in 2020 they started some new rules.  You have to have a Medicare contract with them and also be opted in with Medicare in order to have claims paid.  We have about 10 claims that were denied and I can get no help getting paid.  I have finally got a response, but even with an ICD 10 code, we were told if u are not contracted with them and opted in with Medicare they will not pay.  This is for Alabama.  Each state may be different.  

[wendysmithey]

Thanks,

I do know Medicare offerings vary based on zip codes.  We have never had any problem with receiving an out of network payment when the plans were under a separate dental rider.  I just have never had a claim denied for lack of an ICD-10 code.  Can Carestream offer any guidance?  Is there an add on package I need to be able to add these codes.  The best part of it all was the EOB we received from Humana had a column for everything BUT an ICD code