Tricare Prime, Speciality Pharmacy Accredo, Billing Codes 2017

Survivorgal

Hi All!

I so pray someone can help. I am looking for some feedback from possibly an oncology billing/coder who can help with a billing/coding issue. My oncologist can order my chemo meds through Accredo (Tricare's specialty pharmacy) and Accredo will bill Tricare directly for the drugs so that the clinic does not have to bill for the chemo drugs.

However, the issue is that Tricare kicks the cancer clinic's claim back every time they bill the administration part of the chemotherapy because it is not "attached" to a chemotherapy in that billing. Administration meaning the butterfly needle, band-aids, etc. that the clinic uses in the administration of the chemotherapy drug. My clinic is now ready to get out of the network due to all the hassle and no one can "find" the code.

I have searched high and low for an answer. Gone all the way up the Tricare ladder to determine what code the onc clinic can use so they can be paid their administration costs. The clinic manager has been searching high and low, calling and speaking with everyone she can and I have done the same.

We simply need a code that Tricare will not kick out for the administration costs of the chemotherapy drugs that were ordered from Accredo (Tricare's specialty pharmacy) and that the clinic is not buying and billing.

Any clarification here I can provide it and ANY help would be greatly appreciated (hopefully a special code that Tricare will not kick the claim back to clinic.)

Thank you for any feedback on this request as I know my clinic is not the only one out there that has had this issue. If anyone knows another forum where I can ask this, that feedback would be greatly appreciated as well.

Hope everyone out there is doing well as possible.

Your Stage IV Breast Cancer Sister,

Jennice