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.
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.