Novitas Claims Processing

Another brief note on a payer making unilateral or non-notified changes. Novitas’ current yet confusing policy notes that ancillary veins and perforators may be treated. What they do not spell out is how many ablations will be allowed per patient.

The claims payment edits in Novitas currently allow only four ablations – even if they are a second insertion. This is not supported anywhere in the Local Coverage Determination they have published. As such, we believe this is completely improper and should be reversible upon appeal.

Please ensure your billing department is looking for these denials and is acting on this inappropriate denial in an aggressive fashion.

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