Therapy claim incorrectly processed as “hospital/facility based service”
Hello,
My standard, regular, outpatient mental health therapy claims (for an out-of-network provider) are being denied for any reimbursement. The customer service rep stated that this is because my claims were coded as a “hospital/facility based service.”
I have other outpatient therapy claims (for a different out-of-network provider) that were processed seemingly correctly, and I am receiving a check for reimbursement. Only the providers are different; they are the same exact service and CPT codes.
My question is – why would one provider be incorrectly coded as a hospital/facility based service, while another provider is not?
On the Superbills I submit, both providers have their individual NPIs listed. They both work for themselves in a private practice.
Additionally, the customer service rep told me she sent my claims in again “to be reviewed.” She stated she would follow up with me. I have not heard back from her in over a week.
Any insights would be extremely appreciated.
submitted by /u/OrangeCatOrangeSoda
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