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Multiplan, Zelis, MARS, Viant, Three Rivers, HRGI, and Data Isight are just some of the companies that contract with commercial carriers to reduce out-of-network costs. They accomplish this in several ways: Shadow networks; These are networks that solicit members from both the provider side and the insurance carrier side.
The claim was processed and allowed $$$$$ with a "Zelis Choice Adjustment" of $$$$$, resulting in a payment of $$$$$. However, we have not contracted for a "Zelis Choice Adjustment" for XXXXXXX insurance company, rendering this adjustment unauthorized. Please see prior claims for this patient of MM/DD/YYYY (eob attached) for correct processing.
For example with closure gastrostomy surgery 43870, we are getting a denial for dx code K31.6 (fistula of stomach & duodenum). I have been using these codes together for years. I checked the coding software I use & K31.6 is the number 1 code listed under 43870. Whenever I call Zelis they provide zero help.
Hi, so I am getting increasingly frustrated with Zelis coding denials. I keep getting "Procedure not compatible with diagnosis" denials. For example with closure gastrostomy surgery 43870, we are getting a denial for dx code K31.6 (fistula of stomach & duodenum). I have been using these codes...
The Current Procedural Terminology (CPT ®) code 50220 as maintained by American Medical Association, is a medical procedural code under the range - Excision Procedures on the Kidney.
Table A: AMA calculations for physician costs after capping ACH EFT transaction fees. In terms of an average comparison per transaction, Medical Economics reported that according to the Coalition for Quality Affordable Healthcare, which is the group that created operating rules for the HIPAA electronic transaction standards, “The average provider savings from automated payment posting is $4. ...
The Current Procedural Terminology (CPT ®) code 52332 as maintained by American Medical Association, is a medical procedural code under the range - Ureter and Pelvis Transurethral Surgical Procedures.
Through Dec. 31, 2024, there are no geographic restrictions for patients or providers. For Medicare, use the place of service code that identifies where the patient is located: POS 02 when the patient is not at home or POS 10 if the telehealth is provided in the patient’s home.
CPT Code 99453, Non-Face-to-Face Services, Digitally Stored Data Services/Remote Physiologic Monitoring - Codify by AAPC
The nation's largest medical coding training and certification association for medical coders and medical coding jobs.