Is anyone else experiencing Blue Plus paying less (over $40 less) per each 90837. It looks like this started around July 1st? I called Blue Plus, the Rep was unaware of any fee schedule changes and he submitted a ticket to have it get looked at. Since then, I have had two other mental health clinics in our area report that they are also receiving a lower payment. Is this affecting anyone else?
We recently received rejected claims from BCBS PMAP for not having clinical documentation sent to the claims department. We have never encountered this problem before. I was told by a representative that I we needed to submit clinical for authorization AND to the Billing/Claiims department at BCBS? Has anyone else run into this issue? I was told by the representative that I can submit this information through Availity, although she couldn't tell me how? If anyone has any suggestions or comments, I would great appreciate it! We are billing for CD treatment residential treatment services. Thank you!
I am wondering if anyone else is having issues with the primary EOB information being sent along with claims? I have noticed with our Wilson McShane (BCBS) claims and some of our UCare PMAP claims, we send it to secondary with the primary payment information added into the "COB" tab in Procentive and they still come back denied. For many of the claims I have to fax in paper copies of the EOB's otherwise the secondary insurance cannot see it any they deny. Any suggestions?
Has anyone else seen denied claims from BCBS pmap (LMN... policy) and been told it is because the member is in a Restricted Recipient Program?
This note is from MNits regarding this type of policy/program:
Restricted Recipient Program:
Some MHCP recipients are required to receive the following services from specific providers: Inpatient Hospital, Pharmacy, Physician Services, Mental Health, Outpatient.
The frustrating thing is that you do not know the member has this "restriction" unless you actually call BCBS or first check Availity and then check MNits. It is NOT indicated on Availity at all. So when a client gives you their BCBS pmap card and you check Availity for active coverage, you then have look at the image of the card to get their MA #, then login to MNits to see if they have this type of program.
Also, the BCBS rep told me authorization is NOT an option for this type of program and our only option for possible payment would be to appeal for medical necessity.
Help anyone! Thanks, Sara
We bill R25-CCDTF as secondary for qualifying clients. I have noticed that I am updating the COB and it leaves our clearing house correctly but in MNITS and on our ERA from MN DHS they are paying the full (original) rate...
Currently I go out and update the rates in MNITS via a replacement claim. I have a call in to them but wanted to see if anyone else has come across this???
Customer support service by UserEcho