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Submitting ARMHS claim code H0031 to BCBS

Jonathan Beulke 4 years ago in Codes/Rates/Diagnosis Modules updated by crystalp 4 years ago 5

Our company is having some difficulty submitting claim code H0031 (Functional Assessment) to Blue Cross Blue Shield as they are not recognizing our unit formula: 1unit=15min, and is rejecting our claims. Does anyone have experience with submitting H0031 to BCBS, and if so, what do you claim for the units? I submitted a ticket on this and our Procentive support agent suggested we bill it as only 1 unit but check with the community.

Thanks for the assistance!

We have done some extensive work looking into this with BCBS. We have been told that they were following the AUC guidelines that was only allowing one unit. We did bill our claims up until 7/6/16 with one unit and got paid for that one unit. After 7/6/16, they are now allowing the 15 minutes = 1 unit. We also then had an issue with some of the claims that rejected being denied for Timely Filing and are working with our Contract Manager to get these processed through.

Thank you for your help on this. I received a call from BCBS this morning as I had spoken with them yesterday about this issue. They said there was a software glitch on their end which caused the rejections for H0031 claims containing more than 1 unit. The woman said this glitch is fixed and we should be able to bill this code with multiple units. I re-submitted the claims, and I'll update when I get our electronic report from them.

Is this BCBS commercial or BCBS PMAP or both? Our clinic is have many issues as well with codes H2019 U1 and H2019 U1 HQ which are DBT codes. BCBS PMAP is really underpaying the H2019 U1 codes (not all claims, but a lot of them). BCBS commercial with the clients who have the new ID's and their claims process through BCBS new system, are not paying us the correct allowed amount for both of the DBT codes. In all of these instances, each claim is underpaying by about $120-$150. I've been in communication with our BCBS Network rep but things are still not resolved. My co worker is now working on the BCBS PMAP claims and creating a spreadsheet to send to them so they can look into the claims that processed incorrectly.

For us, this issue is with BCBS PMAP. We are also getting underpaid with every single claim sent to BCBS. They state they follow what DHS posts, which is what we have our coding set to. We've been dealing with this since we contracted with BCBS back in March. We were able to send our information to their Corr team which sounds like what you are in the process of doing. I sent the information in early April, and have yet to get a response from them. The rep I spoke to yesterday said they are significantly backlogged but she stated she flagged our issue and should be getting a response within a month. Sounds like BCBS has been dealing with a lot of issues this year! I'm not sure if this is the same for BCBS commercial, as we currently don't have any clients with that insurance.

Thanks for the input. Yes, we have heard they have a huge back log for processing claims in a timely manner, I see this mostly with BCBS PMAP.