DENIED ANTHEM CLAIMS

Many of us have recently received denied claims from Anthem indicating that the “Services required a pre-certification that was not obtained.”

Representatives of the Colorado Chapter APTA have been working with Anthem of Colorado as well as National APTA and AIM Specialty Health to understand why this is occurring and what our members can do to receive prompt payment.

As we have been previously notified, the pre-certification requirement by AIM for Anthem has been delayed in Colorado until 2/1/2020 and no pre-certification for Anthem clients has been required since August 1, 2019.  Beginning 10/1/2019 many of our members began receiving the denied claims.  It has taken several weeks and multiple attempts to obtain an answer as to why this was occurring. We have recently been notified of the following:

“One of the Anthem claims systems (WGS) was configured for the auth-claims stop only until 10/1/19 so claims coming in after 10/1 were erroneously looking for an auth from AIM. The Claims team at Anthem is getting that configuration corrected expeditiously and doing a claims re-processing project to pay those dates. There is no additional work needed from the providers, but as always you can call the Anthem Customer Service number on the denial letter for further information.”

We highly recommend you do the following:

  1.  Contact Anthem immediately either by phone or the online portal and request reprocessing of the claim as the service did not require precertification.
  2. Keep track of all denied claims and monitor when/if the claim has been reprocessed.
  3. Colorado has prompt payment laws (30 days for electronic claims and 45 days for paper claims). Here is the link to the APTA webpage with the details for each state: http://www.apta.org/Payment/PrivateInsurance/PromptPaymentLaws/     
  4. You and your patients can file a complaint with the Insurance Commissioner of Colorado: https://www.colorado.gov/pacific/dora/consumer-complaint-portal
  5. Provide information to Colorado Chapter via an upcoming survey (late November) so that your representatives are prepared with data when we meet again with Anthem of Colorado in December.

APTA CO will continue to engage with national leaders on this important issue and provide timely updates to membership.

Respectfully,

Cameron W. MacDonald, PT, DPT

APTA Colorado President

Audrey Waldron, PT, DPT
APTA Private Practice Chair

Stefan Van Dursen, PT, FAAOMPT, Cert MDT, MTC, MSc
Interim Practice Chair


 

Gov. Polis Signs 'Return To Play' Legislation Supported By APTA Colorado

HB19-1208, Physical Therapists Youth Athletes Head Trauma, also known as the "Return To Play" bill, was signed into law on May 6, 2019, by Colorado Gov. Jared Polis. APTA Colorado leaders and government-affairs professionals attended the signing along with other PT supporters in the community.

The chapter thanks Representatives Jonathan Singer and Lois Langraf and Senators Rhonda Fields and Bob Gardner for carrying this important legislation.

Current law states that if a youth athlete is removed from play because a coach suspects the youth athlete has sustained a concussion in a game, competition, or practice, the coach or other designated personnel shall not permit the youth athlete to return to play or participate in any supervised team activities involving physical exertion until the youth athlete is evaluated by a health care provider and receives written clearance to return to play from the health care provider. The bill adds licensed physical therapists with training in pediatric neurology or concussion evaluation and management to the definition of "health care provider" for this purpose.

As always, thank you to our PT, PTA and student members. Our legislative activities would be impossible without your continuing support!

 

Donate to Colorado Physical Therapy PAC

We appreciate your donation to the Colorado PT PAC!

The Colorado Physical Therapy PAC is an affiliate organization of the American Physical Therapy Association Colorado Chapter. It is dedicated to raising money to support the campaigns of political candidates. Participating in the Colorado PT PAC creates a way for individuals to collectively support candidates of both political parties who have demonstrated a willingness to consider and support our agenda.

CLICK HERE TO DONATE

As a reminder, this donation is not deductible as a charitable or business expense. Also, the donor must not be reimbursed for the expense by their employer, school, or other entity, nor may the donor be a business.

Per Colorado law, individuals may contribute a maximum of $575 per House of Representatives election cycle (2 years). There is no minimum donation level.

Colorado is a Direct Access State

Colorado is a direct access state, which means that obtaining a referral by a physician or other health care provider for physical therapy treatment is not necessary in order to receive care from a licensed physical therapist. (Colorado Dept. of Regulatory Agencies, State Physical Therapy Board)

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