AdministrativeHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsFebruary 20, 2025

Doula and OB delivery claim denials

Our Operations team identified specific issues in the claims processing system, and configuration updates will be completed on March 14, 2025. These updates fixed incorrect denials of certain claims and improved the accuracy of our claims processing.  

Below, you will find detailed information about the identified issues and forthcoming updates:

Doula Claims Denial (k71 ‑ Required Proc Not Paid or Identified with CARC B15)

Doula claims were being incorrectly denied when associated with OB delivery claims not billed with delivery codes 59409 or 59514.

OB Delivery Claims Denial (f04/f05 with CARC 119 and f06 with CARC 259)

OB delivery claims were being denied due to pregnancy maximum exceedance when there is a doula claim in history that paid for the same date of service. The system was updated to exclude doula codes 59409HD and 59514HD from this edit, as doulas are support providers. Consequently, non-doula delivery claims will no longer be denied when there is a doula history claim billed with 59409HD or 59514HD.

Reprocessing of affected claims

By May 15, 2025, all affected claims will be reprocessed.

Contact and support

If you have any questions about this communication, call Provider Services at 800‑901-0020.

HealthKeepers, Inc. is an independent licensee of the Blue Cross Blue Shield Association. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

VABCBS-CD-078558-25, VABCBS CD-071977-24