We are getting some denials from United Healthcare when we submit claims to them with J codes. In the procedure description area on the CMS1500, it always starts with a "ZZ". For J codes, there is a special format that needs to be used to report NDC numbers, etc. In that instance, the line cannot begin with "ZZ". How can I remove the ZZ from drug lines of service?
I still need descriptions on the claim for all lines of service that are not J codes, though. The descriptions for those lines of service (CPT, HCPCS) can start with "zz".
For J codes, I definitely need a description (which is a formula set by carriers to include the drug's NDC code, dosage, etc.), but that description cannot start with "zz". In our case, the line must start with "N4".
Here is an example of what United Healthcare requires.
After researching i found a CR ( change request ) for this issue in the works, not sure of a release date on it. In the meantime claims are supposed to be sent as normal and if a rejection is received contact us with the information and we have someone that will fix it internally and resend on your offices behalf.
@stu any update on this CR? You posted over 2 years ago about his change request and still nothing. I just called into support and they still expect us to call in for each claim and wait for the case to be escalated and they will fix. Kind of seems like you aren't fixing the issue and making it so time consuming for users to do workaround that no one will do it. Best of both worlds for WinOMS.
I do not have an update on this but will inquire to see if any changes have been made.
Has any progress been made on this change?
I just checked on the status and the NDC Codes and the format are being developed to add to Winoms for a future release. However, there is no ETA as yet. The good thing is that there is finally some progress being made to implement this in the sw. Will keep our clients posted in Release Notes once the new feature is added. For now, you can continue to submit any denials for NDC Codes to Support and someone will resubmit the claim in the correct format on your behalf.
I hope this addressed your concern.
I am wondering if this fix has been been put on an update yet and resolved?
Thank you for Carestream's offer of assistance. I don't think we are looking to effectively outsource our billing for claims with J codes, as much as just have the appropriate line description from the beginning, as required by the medical carriers.
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