07/26/2021

Fidelis Denials for 11720/11721 with 11055/11056/11057

With Fidelis for 11720 or 11721 with 11055,11056 or 11057 we are getting the denial on the EOB " can not be billed without a prerequisite procedure" but when we call and speak to a representative they say it is denied because it is "mutually exclusive". How do we resolve this?

The denial would need to be appealed with the supporting documentation (office notes) within the appeals timeframe with Fidelis Care. You will need to explain the medical necessity and documentation to the managed care plan to justify additional reimbursement. Fidelis is following the same trend as other major insurances to bundle routine foot care services even though the denial is inconsistent with Medicare payment guidelines for the same services.