Provider Credentialing: Problems with 2013 CPT Codes

With the dawn of the New Year comes so many opportunities to begin again, but so do the chances that insurance companies will mess up the medical billing for those who have been provider credentialed.

Those who have been through provider credentialing are now having difficulties with the new CPT codes of 2013. Mental Health providers are facing self-billing challenges. The new CPT codes are causing problems for those all across the nation.

An Example from a Medical Biller:

I spent hours on the phone today with Anthem (BCBS) because they are denying claims with the new code of 90834 (formerly 90806). I just found out Cigna has done the same thing. No problems with Aetna and UBH, though! Anyone else having this issue? Anthem directed me to fill out an appeal – shouldn’t they have to be compliant, just as we are required.

Oh, the insurance companies. We have a love hate relationship with them. As a provider, we love when they fill the claims, as a biller, we hate when there is a problem.

The Problem:

Although you took the time to prepare for the new CPT codes, you read all of the latest blogs, and even called to verify, the insurance companies did not prepare their computer systems for the new CPT codes.

What happened? The insurance companies were prepared to accept the new codes, but the computers were not. Things got complicated when providers were sending in claims from Dec of 2012 with the old CPT codes, and the same computer systems were trying to process the new CPT codes of 2013 with claims made in January of 2013.

Because of that, you have probably heard back that your claims are “pending”, failed, or you need to resubmit the claims. The only problem: Your time to submit the claim is running out.

What does the law say?

Nothing. There are no laws that can help you with your payment war. You have to wait, call, and wait some more. Or call us at 1-855-664-5154 and let us handle your medical billing.