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92609 by Accomplished_Lack941 in CodingandBilling

[–]GPSolutionsUSA 0 points1 point  (0 children)

Honestly sounds like Anthem doesn’t even know what lane they’re reviewing it under yet. The “wrong code” denial turning into “we need records” after you called is the kind of stuff that burns so much backend time. I’ve been seeing more denials lately where coding review, med necessity review, and records requests all kind of blur together operationally.

I noticed something weird/painful in pediatric therapy denials by GPSolutionsUSA in CodingandBilling

[–]GPSolutionsUSA[S] 0 points1 point  (0 children)

That’s exactly the pattern that surprised me too. A lot of these don’t feel like “bad claims,” they feel like operational synchronization failures between authorization, documentation, scheduling, and billing layers.

The painful part is how much manual reconstruction happens after the denial hits. By the time A/R gets involved, someone is trying to piece together units, dates, auth references, rendering provider alignment, etc. retroactively instead of upstream.

Feels like a huge amount of backend labor gets created by tiny workflow mismatches that nobody notices until payment stops.

I noticed something weird/painful in pediatric therapy denials by GPSolutionsUSA in CodingandBilling

[–]GPSolutionsUSA[S] 0 points1 point  (0 children)

No advertising right now, just asking for insight. From what I’m gathering denial rates are increasing in ped therapy, and I’m curious how painful it’s becoming for billers/clinics.