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Medicaid- Procedure limit denials
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6/14/2016 at 6:09:27 PM GMT
Medicaid- Procedure limit denials

For custom rehab wheelchairs, we are submitting and receiving approvals for new wheelchairs and accessories.  When we submit the claim, we are receiving denials on some items for ex.  "Procedure limit of 1 every 2 years" or other similar denials for limits.  We have been told by Medicaid to contact customer service and they can give us history for a HCPC code for that patient.  We have tried this without success.   Until recently, we have been reliant upon GMCF approving the equipment as the green light for coverage, however, that is no longer the case.   

I wanted to ask if anyone else if having these types of denials and also, if anyone has had success in obtaining same or similar equipment information from Medicaid prior to dispensing equipment to the patient and billing?  

Thank you in advance.

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