Thanks, all. I'll take Somarco's advice and get into the weeds regarding diagnosis and treatment codes with the billing provider(s) and carrier before proceeding with CMS.
Good.
And stop believing customer service reps. They are getting paid to read to you from a computer screen. I'm sure they are giving the info they have, but just call and tell them you want a supervisor. Tell them you want the claim reviewed and ask for the appeal process, "just in case" you need it after this call.
Never, ever take a no from a front line person.