Complete Story
09/09/2008
Anthem Blames New Software
Claims rejected based on provider type and diagnosis code.
An OSCA member recently reported receiving a denial from Anthem as "inconsistent with provider type." The claim was rejected based upon specialty or type of provider along with the diagnosis code. Upon phoning Anthem, the member was informed that the rejection was a result of a new software system installed for claims processing and it reportedly "has a few bugs in it". The operator manually overrode the program in order to clear and approve the claim.
If you experience wrongful denials, we encourage you to call the carrier first to calmly discuss the denial and review the file. In most circumstances, they will override the system and manually enter the claim resulting in proper reimbursement. If you continue to be denied, file a written appeal to the carrier. Following this process allows you to then file a complaint with the Ohio Department of Insurance.
