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Blue Plus Payments

Paula 3 years ago in Payments/ERA Modules updated by sarah 3 years ago 65

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?

Yes! Major decline in payments here at River Counseling! I heard it was global affecting all clinics so I let it alone feeling like there was nothing I could do. Im glad you called! Please keep us posted of what you learn...

Would anyone happen to have a copy of the new fee schedule? I requested one but they never sent it.

My email is tbelcher@greaterminneota.org

I'm working with the Star Tribune.  Looks like they will be writing a piece soon!

I, too, have requested it twice and not received it.  I would also appreciate a copy, if possible.  If you send to tbelcher, please include me:  sherylmATsteppingstonetherapeutic.com.  Thank you!


Sheryl

I also requested one and have not received it. If anyone has a copy please send it to tvanovermeiren@northwoodchildren.org

Thank you

I have requested one as well. Will forward to all if it arrives! Would appreciate a copy of anyone else receives one.


sarah@lighthousecfs.com


Thank you!

II did not receive a response for over 2 weeks and called BCBS back-  The correct way to get the fee schedule is to email your company name, address , phone #, NPI & Tax ID to fee.schedule.allowance.request@bluecrossmn.com


I received the schedule within 24 hours.

Many of us have done that but not received it.  What are they trying to hide?  Would you mind forwarding it?

I called BCBS this morning as it is affecting claims back to June 1st for us. They are asking Providers to Fax a spreadsheet of affected clients, dos, Claim# etc...  to Attn: Claims Dept BCBS of MN #1-800-793-6928.

Yes, I spot checked some claims and as far as what I've seen the lower payments after for services dates  July 1 and after, but I will keep checking. About $40 less for 90837 and $19 less for 90834.

Looking a little deeper into the "reduction" of Blue Plus payments, it looks like BCBS Commercial, BCBS Federal and other BCBS plans have been affected too!

I did received the new fee schedule for BCBS as of 7/1/17.  We are definitely getting paid wrong!!  I am going to analyze it more over the weekend.  Will keep you posted.

Hello Pro Community,


I'm late into this conversation. What has been the resolve for incorrectly paid claims? I've been advised to obtain a 2017 Fee Schedule. If there is a discrepancy, we should send an appeal. I don't find that helpful since this event has hundreds of incorrectly paid claims. I appreciate your response. Thank you in advance.  

I have also been waiting for more info on the topic. I was advised to request a 2017 Fee Schedule which I did but it did not include the Blueplus Fee Schedule. I was told they don't have it available yet.

Hi Steph C,


I requested a 2017 fee schedule. The allowed amount rates don't match June allowed amount rates which were higher than July's rates. The July allowed amount rates don't match the fee schedule either. 


The explanation I received by BCBS CSR was to review the 2017 Fee Schedule for the answer. 


Folks, the CSR response was not helpful based on the 2017 Fee schedule I received. I'm challenged with BCBS seeing a resolution for all these hundreds and hundreds of claims that have been impacted by this rate reduction that don't match any fee schedule I've reviewed in the past 10 days. 


Perplexed indeed!

See my response from above 2nd from top... Not ideal at all to pull a spreadsheet to capture all of the info they want. but that is what I was told needed to be done. Procentive doesn't pull in the claim # that they are asking for in any report I could find... so that is a pain. They want name, id, dos/claim# etc... the contact info is on my response above on where to fax it. I asked for a AUDIT to be done on all claims affected under my Tax ID and was told I had to do a spreadsheet.. I am actively working on that and have not sent it in yet... 

Thank you Amy Benson. The task we're asked to do is daunting to say the least. This event has impacted a larger community of people/facilities. This involves hundreds of claims/DOS.  I will attempt to take this event to a higher level. Wish me luck. 


Debbie

I wish you luck:):)!!!! Thank you!!

I'll update this community as I learn more. :)

I spoke with someone higher up in BC and she explained that the lower payouts are correct. On the bottom left of the Fee Schedule excel spreadsheet are tabs: MD, MA etc.. I was looking at the default MD display. I needed to select the MA tab. She said the BC PMAP fee schedule will be out in the next day or two and the payouts are 30-40 less than before.

+1

Hi Steph,


I did review the fee schedule, the tab MA. The MA tab does not match what we were reimbursed at. We were paid lower than the rate noted on the fee schedule. So....I'm back to finding someone who understands the complexity of this event more fully. I appreciate your comments. Thank you Steph C. :)


There has been discussion of these issues on Minnesota Psychological Association listservs.  This seems to be a big problem that requires the resources of professional organizations. If you are a member of a professional organization, you should contact your organization for help. 

+1

Hi Everyone

I have spoken to Dianna, a BCBS Network Management Business Partner, at length and she has answered a lot of my questions.  I have recapped the conversation below, in hopes that you will find answers to your own questions.  The new rate of pay that we are receiving from BCBS is correct.  Dianna has made it clear that BCBS will not be negotiating any rates, “It is, what it is”.  I would not spend any time on creating spreadsheets and sending them into BCBS, unless you know for a fact that the rate you were paid does not match you fee schedule.


  1. In April 2017, everyone received a small packet from Blue Cross Blue Shield MN      

 RE: “Aware Provider Service Agreement renewal”.  (I admit I did not read it.) We were informed that provider service agreements would renew on July 1, 2017.  We would not need to sign or return anything to renew this agreement. 

One of the reasons for the rate change in the (Blue Plus/Medicaid) fee schedule is found on page 6 D. MN Health Care Programs.  For those Health Services provided to MN Health Care Programs Subscribers, Blue Cross will pay Provider for Health Services at the lesser of 90% of Providers regular billed charge or 100% of the Blue Cross medical assistance fee schedule as determined by Blue Cross. 

In the 2016 Provider Service Agreement renewal, found on page 5 D. it was worded, for those Health Services provided to MN Health Care Programs Subscribers, Blue Cross will pay Provider for Health Services at the lesser of 90% of Providers regular billed charge was or 101% of the applicable MN Health Care Programs fee schedules as published by the MN DHS and as determined by Blue Cross. 

Therefore, in 2017 BCBS has created their own medical assistance fee schedule and no longer considers the fee schedule published by MN DHS.


  • July 1, 2017, we providers were to request a list of applicable rate allowances by submitting an e-mail to:  fee.schedule.allowance.request@bluecrossmn.com.  We would have recognized our reduced “new rates” immediately upon review of the codes/allowance.  (I admit, I did not request a new rate allowance on July 1). 

Once you submit a request you will receive a few schedules according to the services that you provide.  For us it boiled down to two schedules, one which included BCBS Commercial plans and BCBS Federal.  The other schedule is the BCBS Medicaid Fee schedule.  When you receive your fee schedule, be sure to look at the tabs on the bottom of the spreadsheet and select the correct one. (MD, MA, PhD, and AMD).  Also, look for columns Non-Facility Allowance or Facility Allowance.  Here is where you will find your pay rate.  Keep in mind, on the EOB’s the 2% for the MN Care Tax will be added to your pay rate. Reminder, BCBS Federal will not include the 2% MN Care Tax.  If you find that the reimbursed rate does not match your fee schedule then you should call BCBS and talk to a provider rep.

Currently the BCBS Medicaid fee schedule is not available and is being tweaked as language needed to be added for Medical Assistance cutbacks.  They should be available in the next day or two.  Anyone who already requested a fee schedule will be forwarded the Medicaid fee schedule when available.  I do know that Master (MA) level providers received a 20% reduction to rates. 

 

  • I did ask if the new rates had anything to do with Magellan taking over the behavioral health of BCBS and she assured me that Magellan and the reduction of pay do not have anything to do with one another.  (Currently, Magellans Medicaid rates would be better than the BCBS Medicaid rates).  As you may have heard, BCBS has asked Magellan to briefly pause and the transition to Magellan will not take place on January 1, 2018.  It may be July 1, 2018 or even in 2019.


  • Regarding the new fee schedules Dianna, at BCBS, did state that “BCBS did not make this decision lightly.  There were a lot of areas of the company involved in discussions, including some of our clinicians.  There was also quite a bit of research done behind this change.  As I have been fielding calls I have been told that the current commercial rates are more aligned with our competitors.”  This may be true, but the Blue Plus/Medicaid rates are ridiculously low and do not come close to aligning with their competitors.

  • I agree with Procentive user Richard Sethre, PsyD. L.P. “There has been discussion of these issues on Minnesota Psychological Association listservs.  This seems to be a big problem that requires the resources of professional organizations. If you are a member of a professional organization, you should contact your organization for help”.

 

 I think as providers, that we need to push back.  Call BCBS and comment on the new fee schedules, write a letter, call your Rep, get your professional organization involved.  Do something!  Do not be apathetic! Let BCBS know how we are affected by their decision.  

Thank you

Paula 

I have forwarded this info to Chris Serres at the Star Tribune.  He seemed quite interested.  I'm not going to sit and take this.

Great idea!  If the StarTribune thinks that it is newsworthy, and publish an article, this could really get BCBS MN's attention.

Continued...

One thing that I should add, regarding my conversation with Dianna, is that the BCBS committee, that made the decision to reduce the rates, first looked at eliminating the 90837.  She said the majority of therapists bill this code and BCBS is concerned if therapists were really meeting for 53+ minutes and documenting their time accordingly on the process note. They thought there might be some 90837's being billed per client, but they believe that the 90834 should be billed the majority of the time.  So instead of eliminating the 90837, they decided to reduce rates, across the board, to the 6 commonly used CPT codes.

Thanks

Paula

This is exactly what the current President of the American Psychological Assoc., Tony Puente, Ph.D., predicted. He is a CPT  coding expert and predicted that billing for 90837 in ways that insurance companies view as excessive will result in reduced reimbursement. We are likely to see more of this from other companies. 

Thank you Paula for doing so much work on this and thoroughly explaining it to all of us.  I really appreciate it!

I appreciate this forum. It has real value. I extend my appreciation to all those who have offered comments. Paula, your explanation is exactly what I was looking for. No doubt your path took you alot of time to get to the core of what happened. Thank you so much. Richard Sethre, PsyD, LP, I agree with your comments. I believe other insurance companies will review billing 90837. I expect rate reductions from other companies are forth coming. 

I have already come across United Healthcare that does not recognize 90837-they don't think this code is necessary. They are using the 90834 code, won't even give you a PA for 90837.

I agree with you Richard.  UBH commercial plan have been doing this since last year, not paying for the 90837 unless there is a certain DX and they are prior authed. and I also believe we will get more push back on this from other insurance companies.


Thank you Paula for the work and time you have put into this and for sharing with all of us. 


I will be reaching out to our MACMHP association about this along with DHS.  We are one of the first implementers for the CCBHC demonstration project and have some contacts at DHS that will be interested in this.


We went through this similar process with UBH pmap a couple of years ago and they eventually increased their rates to the MA rates.  But probably not after we threatened to terminate our contract with them.  Though if enough of us do that, BCBS will have to listen.  This of course would be last resort as we would want to take care of our clients the best we can.


Thanks!

Medica sent the following out in June:


June 15, 2017


RE: Billing of Extended Sessions (CPT Code 90837)


Dear Provider:
Beginning in June 2017, Optum, in coordination with Medica Behavioral Health, will expand our management processes to include extended sessions for Medica commercial plans. Quality Management applies data analytics to identify potential atypical practice patterns. To see guidelines, visit Provider Express > Quick Links > Guidelines/Polices/Manuals >
Behavioral Clinical Policies> Outpatient Psychotherapy lasting 60 minutes or greater. Behavioral Clinical Policies are available on providerexpress.com (under “Quick Links” select “Guidelines/Policies”). They provide assistance in interpreting and administering behavioral health benefit plans that we manage. Individual outpatient psychotherapy is generally provided in sessions lasting up to 45 minutes. Extended outpatient sessions are individual psychotherapy
sessions with or without evaluation and management services lasting 60 minutes or longer. Coverage for extended outpatient sessions may be indicated in several non-routine circumstances. It is recommended that you review the guidelines on Extended Outpatient Sessions to enhance your understanding of our expectations. Coverage Rationale
Outpatient psychotherapy sessions lasting 60 minutes or longer are proven and medically necessary in the following non-routine circumstances: · The member is experiencing an acute crisis, is not at imminent risk of harm to self or others, and psychotherapy for crisis is appropriate for providing rapid and time-limited assessment and stabilization. · CPT 90840: Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service)

OR

· An individual psychotherapy session with evaluation and management is being provided, and there is an unexpected complication resulting from pharmacotherapy, or an acute worsening of the member’s condition that would likely require a more intensive level of care if the outpatient session is not extended.

Service Online Resource
Routine Session: CPT Code 90832 30 Minute Session
Routine Session: CPT Code 90834 45 Minute Session
Non-Routine Session: CPT Code 90837 See guidelines from Provider Express:

“EXTENDED SESSIONS”
United Behavioral Health operating under the brand Optum BH1008_062017

OR 


· There is periodic involvement of a child, adolescent, or geriatric member’s family in a psychotherapy session, and such involvement is essential to the member’s progress (e.g., psychoeducation or parent management skills are being provided). o This is not synonymous with marital or family therapy.

OR

· A psychotherapy session lasting 60 minutes or longer is otherwise needed to address new symptoms or the re-emergence of old symptoms with a rapid, time-limited assessment and stabilization response. Without this session, the new or re-emerging symptoms are likely to worsen and require a more intensive level of care. Outpatient psychotherapy sessions lasting 60 minutes or longer are proven and medically necessary in the following circumstances as indicated by the member’s condition and specific treatment needs: · The member has been diagnosed with posttraumatic stress disorder, panic disorder, obsessive compulsive disorder, or specific phobia, and is being treated with prolonged
exposure therapy;

OR


 · The member has been diagnosed with posttraumatic stress disorder and is being treated with eye movement desensitization and reprocessing (EMDR) or traumatic incident reduction (TIR);

OR


 · The member’s borderline personality disorder diagnosis is a covered condition, and the member is being treated with dialectical behavior therapy (DBT). Outpatient psychotherapy sessions lasting 60 minutes or longer are unproven and not
medically necessary outside of the above circumstances and conditions. · There is limited evidence regarding the use of extended outpatient sessions outside of those specific circumstances and conditions described above. · The efficacy of extended outpatient sessions outside of the above indications has not been verified in well-designed controlled trials. The requested service or procedure must be reviewed against the language in the member's benefit document. When the requested service or procedure is limited or excluded from the member’s benefit document, or is otherwise defined differently, it is the terms of the member's benefit document that prevails. Per the specific requirements of the plan, health care services or supplies may not be covered when inconsistent with Level of Care Guidelines and/or evidence-based clinical guidelines. All services must be provided by or under the direction of a properly qualified behavioral health provider.
If you have any questions about this notice, please call Network Management at (877) 614-0484 and select option 5. 


Sincerely,

Tara Nguyen, MA, LMFT
Senior Clinical Quality Analyst


Here is a small positive...

If your BCBS client has a secondary insurance, the secondary is now paying something (prior to July 1st it usually was a write-off), because the secondary allowed amount is higher than BCBS.

If you google "Medica sues DHS" you will find that BCBS received a raise for PMAP members when Medica withdrew from the market.  That is, if what Medica is saying is true.  There is also another reporter listed as well.  Wonder if we should forward what we are discussing to him?

My Clinical Director talked with a BCBS representation today and was told that BCBS created their own Medicaid fee schedule and yes, it is lower than DHS.  The only way for providers to know about the reduction in both commercial and PMAP rates was to request a fee schedule.

I just called to request a the BCBS PMAP/MA fee schedule and was advised the only way you can get a copy is to do an email request to

c_schedule_allowance_request@bluecrossmn.com

Hope this helps!

Thank you! Just requested my copy!

Begin forwarded message:

From: Minnesota Association for Marriage and Family Therapy <info@mamft.net> Date: August 16, 2017 at 12:58:10 PM CDT  Subject: Fight for Mental Health Care: Join Us September 14th! Reply-To: info@mamft.net


Blue Cross Blue Shield Minnesota just cut rates by 33% - this will put mental health clinics OUT OF BUSINESS

FIGHT FOR MENTAL HEALTH CARE!!

The government is NOT making changes in Healthcare, the Health Insurance companies ARE and they AREN'T TELLING YOU!!! THEY ARE making their OWN moves with YOUR MONEY and HEALTH! They are limiting YOUR ability to access mental health while hurting the providers who keep YOU AND THE COMMUNITY SAFE!

 

Blue Cross Blue Shield Minnesota just cut rates by 33% - this will put mental health clinics OUT OF BUSINESS

Blue Cross Blue Shield is partnering with an insurance company KNOWN TO DENY MENTAL HEALTH CARE and PAY EVEN LESS!!!

 

Many major insurers in MN are limiting care and NOT ALLOWING experts into their networks so people have affordable access to the right kind of care.

Mental Health Care KEEPS YOU AND YOUR KIDS SAFE!! Even if you aren't directly impacted by seeing a therapist, someone who you know is. 1 in 4 PEOPLE ARE IMPACTED BY MENTAL ILLNESS. THAT'S EVERY SILVER CAR ON THE ROAD! That went up from 1 in every 5 just last year! YOUR LIFE IS PROTECTED BY MENTAL HEALTH CARE WORKERS EVERY SINGLE DAY!

JOIN US FOR A PROTEST OUTSIDE of Blue Cross Blue Shield Minnesota on Thursday September 14th starting at 7:00 am. 3535 Blue Cross Rd, Eagan, MN 55122

Sign Making from 2:00pm to 9:00pm on Tuesday September 12th at Cedar Valley 3460 Washington Drive #206, Eagan MN 55122

 

For more information join the facebook group Fight For Mental Health Care

Click here for the event flyer and please spread the word!

 

MN Association for Marriage and Family Therapy

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BCBS is cutting rates!  What can You do about it?  Please read!


Below is an email link to KSTP - Channel 5.  Please use their "News Tip" link to share what BCBS is doing to mental health.  Ask Channel 5 to JOIN US FOR A PROTEST OUTSIDE of Blue Cross Blue Shield Minnesota on Thursday September 14th starting at 7:00 am. 3535 Blue Cross Rd, Eagan, MN 55122.  We need  one or more news stations that are willing to cover and report the event.  Please ask everyone in your agency to submit a "News Tip".


http://kstp.com/pages/misc-pages/send-us-your-news-tip.shtml


Thank you

Paula

To the Group and BCBS discussion  - 

I am curious when was the last time that out patient mental health services was funded to match inflation and cost of living? There was legislation to increase 21.7% in 2007 for the "essential services" [in mental health] as defined by state statute, which includes, but not limited to ARMHS and CTSS services. This did NOT include outpatient mental health services. In 2013-14 there was a concerted effort by most of the professional mental health groups with their lobbyists to have a matching increase for out-patient mental health, however failed due to cost, etc, etc.

Thus my question, when was the last time did out patient mental receive an increase for services that matched the "cost" of doing such work? I almost want to say that it was in mid-1990's when it last occurred. Can someone confirm?
Thanks - 
Katherine 

I do not know when the last rate increase was for mental health therapy.  I do know that DHS is looking for participants in a Rate Cost Survey to help them go to legislation to get rates increased.  Here is a link to it - https://mn.gov/dhs/partners-and-providers/policies-procedures/adult-mental-health/service-rates-information/


They did not get a good response from the first one they did late last year.  The are encouraging and hoping to get a lot of response in order to have info to use at the next legislative session.


M

United States Senator Amy Klobuchar - Working for the People of Minnesota


Please write a letter to Senator Amy Klobuchar; it could make a difference!!



Mail to:

Amy Klobuchar

1200 Washington Avenue South, Room 250 Minneapolis, MN 55415

 

Link to E-mail Amy:

https://www.klobuchar.senate.gov/public/email-amy



Thanks

Paula 

Good evening, all.  Got a new one from BCBS today.  Instead of paying 120.86, I have one client they are now paying only 80.09 (Master's Level practitioner).  This is way out of hand; can't keep the lights on at this rate!


Sheryl

Hi,

I hesitate sending our July 1, 2017 Fee Schedule, because of the statement that is included on the top of the fee schedule (I copied the BCBS statement in it's entirety below.)


"including the requirement that all financial information relating to the agreement must be kept confidential. "


I am sure that most of us are receiving the same fee schedule (reimbursement rate), but there may be a few organizations out there, that are probably getting reimbursed at a different (higher) rate, so I am guessing that is why they ask us to keep the information confidential (so that we do not all call in and want to negotiate a higher rate).


I have reviewed the Fee schedules that I did receive and the reimbursable rate on the fee schedule is matching the ERA's. (Sad, but True).  I am not sure why you have not received your fee schedules as requested, but when you do I do not think you are going to find out anything different then what you have been getting paid, for DOS starting July 1st..


Sincerely

Paula


From BCBS on top of Fee Schedule

Provider's receipt of this fee schedule information is subject to all terms and conditions of the provider's agreement, including the requirement that all financial information relating to the agreement must be kept confidential.  All stated payment rates do not include any applicable tax, any discounts, withholds or other contract specific adjustments.  The services identified below are also paid according to the lesser of the provider’s billed charges or the payment amount listed.
This Fee Schedule will not be held as contractually binding and may be revised at any time without notice.  This information is considered proprietary and no portion may be re-released without our express written consent.
Further, the best overall source of specific provider payment is your Explanation of Benefits.  If you have a need for more specific information on the listed codes or other professional services, please refer to your Explanation of Benefits.

Yes, as noted by Paula, for you, or whowever signed your BXBS MN contract on your behalf, agreed - by contract - to not share the BCBS MN fee schedule. If you share it on a public forum you would be putting your BCBS contract at risk. 


Richard Sethre, PsyD, LP

When requesting the fee schedule there is a form that must be filled out to get the fee schedule. My boss did email them and received it a few days ago after filling out that form.

Blue Cross payment cuts prompt protest by Minnesota mental health providers | Star Tribune 


Yes!! -The Star Tribune reported on the BCBS reduction. 


They reported that a letter is going out to MN providers.  It looks like some of the BCBS rates may be re-instated through 2017.


"The insurer said last week that it rolled back some of the rate decreases and that it will delay until January a cut that would reduce payment for the standard hour long therapy session by about 18 percent."


Click below to view the entire article

http://m.startribune.com/blue-cross-payment-cuts-prompt-protest-by-minnesota-mental-health-providers/442808153/


Please read it carefully. They are implementing a "revised fee schedule" retroactive to July 1. It does not mean they are returning to pre July 1 rates. 

We received the letter today with the rates being re-instated through 2017.  


"BlueCross has decided to reverse the reductions retroactive to July 1."

"On January 1, 2018, code 90837 and 90838 will revert to the previously lowered amount.


The bad news..... They have overpaid on Medicaid since July 2015and will be taking steps to recoup payments....

Im reading over the letter we got from BCBS specific to the Fee schedule. I am a Non CMHC center and typically in the past my rates have been higher that the CMHC rate. Am I reading this correctly that the columns are switched (a typo I presume) or is it true that CMHC are getting higher rates than non moving forward? This is potentially  a much bigger problem for those of us who are non CMHC.


Additionally....I appreciate the fact that they recognize their mistake and are willing to adjust and work with us but the fact that they are still going down so low in January is still concerning, that is such a enormous drop in reimbursement. Is there anyone out there who is still making a push to expose this and keep the pressure on the powers to be?

I posted a comment yesterday and no one responded and it does not appear to have gone out, I will cut and paste it here to see if it goes today...



Im reading over the letter we got from BCBS specific to the Fee schedule. I am a Non CMHC center and typically in the past my rates have been higher that the CMHC rate. Am I reading this correctly that the columns are switched (a typo I presume) or is it true that CMHC are getting higher rates than non moving forward? This is potentially  a much bigger problem for those of us who are non CMHC.

Additionally....I appreciate the fact that they recognize their mistake and are willing to adjust and work with us but the fact that they are still going down so low in January is still concerning, that is such a enormous drop in reimbursement. Is there anyone out there who is still making a push to expose this and keep the pressure on the powers to be?


I saw your comment, Alyson, but didn't know the answer!

I have appreciated everyone's comments. Our company is not experiencing rate reductions according to our two experienced billers and in spot checks I have made. However, our billers are new to us so I will continue to check on this. I am very concerned however. My main comment is that we will not be very successful as long as our 'industry' is so dis-jointed in terms of its advocacy. There is not one organization that represents clinicians and mental health entities such as the plans have with the Council of Health Plans. Many of you belong to organizations such as MAMFT and entities belong to AspireMN etc. and some of you are freeloading off the rest of us who pay for advocacy services (hint). But this is too dis-jointed as there is little coordination among all these. We can not rely on NAMI whose main goal is to expand services with a secondary (but real) concern for payment rates. We cannot rely on DHS or Commerce who have shown through successive administrations an inability to properly contract and regulate. I would urge those of you who do not participate in some advocacy organization aside from NAMI to join.  Those of us who do should encourage our boards to join together so that providers have a more powerful voice to create a better platform on which to provide services.   With a stronger and more organized advocacy voice that can be at the hundreds of meetings and tables that change will require we could over the next few years have a better more predictable platform with reasonable expectations and rates. After all, without us there will not be services. Our rates are being reduced because they can and because we are weak and disjointed.  Don't expect this to change without some increased presence.


PS It was great to hear Sue A. on Chad Hartmann on WCCO (who called what BC/BS was doing "criminal") but wouldn't it have been great to have had XXX, the "executive director of the Organization of Mental Health Providers" speaking for us?

Thanks to cmchugh for a very thoughtful comment.  The post makes some, I think very important points, particularly touching on the benefits of being a member of, and supporting, your state professional organization. And, it is time for professional organizations to set aside differences and work collaboratively to advocate for all mental health clinicians.  

Looking for any thoughts, and/or advice regarding BluePlus payments being overpaid during a certain period of time from an error in Blue Cross Blue Shield's system.  This error classified all behavioral health clinics as CMHC, and as a result some clinics were overpaid.  


Thanks in advance!

We just got our bill yesterday.  Not much can be done, apparently the contract states they can recoup overpayments.

We got a bill as well, the claims were from a year ago and they want recoup now. I am using the "you want 6 months notice, so do we" reason but no one has gotten back to me yet. I'll post any feedback from BP

Yes, we receive ours without the detailed report on who was overpaid. I emailed them requesting the detailed report and how it is unreasonable and unprofessional for BCBS to expect an Agency to blindly return funds without a detailed report on what they are repaying.

That is a reasonable request.  They would not pay us without detail.

I also requested this information and received it rather quickly.  Now, it's a matter of going through the claims affected.

It's odd that this error that had been occurring for 2 years, BCBS didn't notice.  Neither did I, as this was already going on when I took on my role at our clinic.  Now BCBS has created their own Blueplus fee schedule, which pays less.  I assume many clinics need to pay them back.    

I agree, Billing Transform.  We actually did not receive any correspondence on August 30, 2017 as they stated in our letter and we could have been more prepared for this.   Please share what their response is, it's much appreciated.



We received ours last Thursday. The date on the invoice was October  25, the attached letter was dated November 6, and was not canceled by the post office until November 13. The Due Date on the invoice was November 25. Please! I called, but they will not give any information over the phone. I will be emailing today for the detail. I agree with the whole timely filing deadline - if we can't file after a specific number of days, how are they able to recoup from over a year ago? 


Our current recoupments (separate from the mailed invoice) are not correct, either. The dates on the most recent recoupments are July and August of 2017. They are reprocessing UA codes at a non-UA rate. And, our IOP DBT submissions are being changed in their system, from a U1 modifier to a UA modifier - which pays at a significantly lesser rate. Has anyone else found this to be an issue? I have an inquiry filed with them, but the person I spoke with said it could take up to 90 days for them to get back to me. The recoupments I was calling about were four pages worth of service lines.


I did email Amy Klobuchar, but got a blanket reply regarding the ACA. I replied asking why they didn't actually read my email prior to replying. I haven't heard back. I found that to be quite disappointing.


We have not received anything other than this new Invoice/Letter from October and November. Nothing in August. Do you think they are referring to those bulletins they send each month? I will have to look through the August notices.

Although the invoice says the due date is 11/25, the letter says that payment in full is not due until April 30, 2018.

+1

Oh, yes. I realize that - but the due date is bunk.

I would encourage everyone to question BCBS on their invoiced amount. They are currently looking at ours again, and will not send it to me, yet. I mentioned that we are CTSS certified, and that the rate is the same whether or not an agency is CMHC. I received a return email saying they were not yet ready to release our information to us, because they are re-evaluating our information.