Blue Plus CTSS claims

Lily 11 months ago in Billing/Electronic Modules updated by Kaci Cooper 10 months ago 4

I am just wondering if anyone is experiencing issues with Blue Plus CTSS claims  getting denied saying  that you need a prior authorization. We starting having issues with claims on 5/18/23 to current. 

Are they specifically CTSS or Day Treatment codes? They are sticking firm to the thresholds (150 units for H2012 codes and 200 units for CTSS) billing. Their most recent bulletin on this topic states they will not retro any auths for day treatment billing but will allow retro (not sure how far back they will go) for CTSS due to the possibility of a client being seen at more than one agency for services.

They are specifically CTSS code H2014 and we have not gone over the 200 hours we are way below that threshold. 

It might be worth a call to Amerigroup to see if they are also receiving services through another agency. That might be why the client has met the threshold. They should let you do a retro, since you have no way to track another agency's billing. Good luck!

Hi, looking to see if you were able to resolve your billing issue as we are having the same issue. They are denying all CTSS H2014. I can't seem to find anyone with an answer to help me on this.