Denials
Medicare gives you 120 days to appeal a denial, an ERISA plan 180, and a claim returned as unprocessable gives you none
A working guide to the two appeal tracks a behavioral health biller actually works — Medicare's five levels and the ERISA commercial ladder — with the filing deadlines, the decision clocks, what a peer-to-peer is really worth, and a reusable letter structure.
Analysis — Aug 24Ohio Medicaid pays $25.33 or $7.32 for the same H2019 unit — the modifiers decide
A working reference to the 27 HCPCS Level II H-series modifiers behavioral health lives on, why HO and HP mean different things in different states, and what NCCI actually says about 59 and the X modifiers in a specialty with no anatomic sites.
Denial Decoder — Aug 23CARC 16 with MA130 is a returned claim, not a denial — and it carries no appeal rights
A working reference to the CARC and RARC combinations that actually land on behavioral health remittances: what each code says, why it fires in a BH context, and whether the answer is resubmit, correct, or appeal.
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