PPO Contract w/ Anthem WC (California)

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PPO Contract w/ Anthem WC (California)

Postby elh919@aol.com on Wed Mar 13, 2013 2:17 pm

Has anyone been experiencing a huge PPO reduction for 2013 charges with Anthem WC. In the last two days, I have opened approximately 20-30 bill reviews/payments from various carriers i.e., Liberty Mutual, Ace/ESIS, Gallagher Bassett, StrataCare, all who utilize the Anthem WC network. The charges that are taking the biggest hit is 90844 45-50 min psychotherapy. Fee schedule is $98.40, and our bills would usually be reduced by an additional $9.84, payment then being $88.56. However, for all bills processed by Anthem WC in 2013, the allowable of $98.40 is being reduce by $48 for the PPO reduction leaving a payment of $50.40 for 45-50 min psychotherapy.

Is there something I am not aware of that Anthem WC suddenly changed their contract in 2013? I have tried calling the phone number that appears on all of the various EOR's, but can't get a live human being, only a recording by a female that sounds like she can't be older than 16 years old, saying a return phone call will be received within 24 hours. Doesn't happen. I was able to speak to one person at a bill review organization and he did confirm that California WC still requires us to use 90844 CPT code for psychotherapy versus the 90806 that Private Carriers and Medicare require.

I know I will be utilizing the new form to request a second bill review, but I would like to have all of my ducks in a row before I start the bill review process.

Any insight would be greatly appreciated.
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Joined: Fri Mar 06, 2009 1:45 pm

Re: PPO Contract w/ Anthem WC (California)

Postby Andrew120 on Tue Mar 19, 2013 2:38 pm

Anthem is abusing the system. A lettern to the audit unit should be sent. 90806 is no longer the medicare CPT code. For 2013, the code for 45 to 50 min psychotherapy is 90834, 90836...for an hour it's 90837 & 90838. You need to update yourself to the new RBRVS codes for Psychiatry. They all changed.
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Joined: Fri Mar 15, 2013 1:05 pm

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