Hi everyone, Has anyone experienced issues contracting with UMR? They require the credentialing process to be completed through UHC, which we have already done for our providers. However, when we submit claims to UMR, they are being denied with remark code M115: "This item is denied when...
So I need some help and this is the only place I figured I could go to get opinions/facts. As of right now my clinic is getting denials for the new telehealth codes from certain insurances. So far it's looking like BCBS, GEHA, UMR, BCBS, Multiplan PHCS, and Ambetter is accepting all but the highest level of video or audio. Billing is stating the insurance has it's own rules and we must follow ...
We are getting paid out of network with UMR and SUREST. When I call and talk to a rep, they do see we are in network, they send the claim back for reprocessing, the claim comes back being paid in network, but the next time the patient comes in, the claim is getting paid out of network again...
Wiki - UMR AND SUREST | Medical Billing and Coding Forum - AAPC
We have noticed UMR will void codes submitted for prior authorization stating "Included with Primary Code Review". Example: We submit authorization for 97162, and 97110. They void the authorization on 97162 and approve 97110 (Therapeutic exercises). CMS allows payment on both codes, but UMR is telling us to only bill 97110 and not 97162, even though no TE was performed on that date. That seems ...