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December 4, 2019 at 2:57 am in reply to: Simponi Aria max units #6040

Nilsa Cruz
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Yes–I am just reading this now as I see recent postings in NORM about this forum and totally forgot I belong to it since March of this year. I have two letters I can submit to this forum, from ACR to Correct Coding Solutions (they administer the edits) and the Correct Coding Solutions answer to ACR. Basically, Correct Coding went thru AMA to announce posting of these limits for comments–and NO ONE COMMENTED, so it was finalized. It wasn’t until the ACR wrote later on (and outside comment period when this became a known issue), but by then it was too late. Correct Coding even wrote to ACR this was the first they even heard about this objection. Having said this, you can appeal the denial to your MAC with supportive evidence, and if medically necessary they will override the edit. It is also POSSIBLE, but not guaranteed, that a MAC could flag that patient’s claims moving forward so as to override their edit. I am not sure where I can post as attachment on this forum those letters, so Cheri, I will send to you via regular email since you are in my WI team.
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