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Anyone else having BCBS Illinois denials for LMFT ?

Kay Defries 4 years ago in Billing/Electronic Modules updated by Kari Droubie 4 years ago 4

At this time I'm just wondering if anyone is having these denials. We may be asking for help!


Our scenario: Starting in August, after BCBS MN had an update to provider types, we got denials for clients who see our LMFTs and have a BCBS IL plan through their employer. We have started an appeal process over these denials. Now BCBS IL has recouped payments made from Jan to July; we've included a request for re-payment in our appeal.

Thanks, Kay

We have experienced the same thing. When we called BCBS of IL they indicated the employer groups plan doesn't cover services with an LMFT. We didn't appeal the denials based on that information. I would be interested to find out if they process your appeal.


Kari

I am currenly dealing with this issue. To process the claims, I now have our LP supervise the LMFTs that have clients with BCBS of IL (particularly the BCBS of IL plan with suffix WLM). Therefore, I send the claims with the LP Name, License and her NPI and indicate a U7 modifier (under supervision). According to the BCBS Rep they are processing these now and I am suppose to get payment next week =).

Kari, I will follow up when we have a response. I can't believe this employer carved out the LMFT when they are paying claims on an LPCC! Paula, We could also do the U7 modifier and re-bill but I'm believing that there is a problem with the BCBS provider update that needs addressing.

Thanks Kay. We may also try billing under a supervisor.