Practice Management

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  • 1.  CT Low Dose Lung Screening

    Posted 10-18-2024 11:45

    Just a little history.  We are a private group reading for a hospital.  The hospital is receiving a payment, but our claims are being rejected. Denial codes 197(No authorization) and 167(Diagnosis not covered). Even though we have an auth and a covered diagnosis. Some of the insurances are Aetna Medicare, Highmark and Highmark Medicare.

    Any help would be greatly appreciated.

     



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    Timothy Gutsie
    Chambersburg Imaging Associates
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    Ventra March25 Post


  • 2.  RE: CT Low Dose Lung Screening

    Posted 10-21-2024 16:09

    Hi Timothy,

     

    Aetna has a known issue with recognizing auths when they were processed through Evicore, in which case you will receive denials.  I would suggest speaking with your Aetna representative and having them manually check claims where you know you have an auth.  We have been working through this issue for 2+ years now and Aetna is finally taking some accountability. 

     

    I am not sure about Highmark but it could be a similar situation.  We also push back with proof of hospital payment for the same exam which would use the same auth #.

     

    Good luck, and hopefully others have some suggestions.

     

    Shannon N. Wilson, FRBMA

    she/her/hers

    Senior Manager, Group Practice Revenue Management|MGB Revenue Cycle Operations 

     




    Original Message
    Ventra March25 Post


  • 3.  RE: CT Low Dose Lung Screening

    Posted 10-21-2024 19:59
    Shannon
    Thank you for your help. 
    Tim
    Sent from my iPhone



    Original Message
    Ventra March25 Post


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