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BCBS commerical plans issue with H2036

Mardi 2 years ago in Billing/Electronic Modules updated by Karen P 2 years ago 6

I have inherited a problem with BCBS commercial plans when billing 1002 and H2036 HA, HH. We bill multiple units for each and on a invoice I have noticed that they are reimbursing as for the Room and Board however they are NOT reimbursing us correctly for treatment services.  When I called BCBS they stated this was because of a date range issue however I have been told by Procentive that is not accurate and that I need to remove the HCPCS code from the claim.  

Does this sound familiar to anyone? what do you do to get your claims paid?  I have noticed that we have been taking LARGE adjustments on H2036 and would greatly appreciate hearing what worked for you to get your claims paid.  

+1

We were having the same issue last year. BCBS has indeed changed their coding preference to just the revenue code. They no longer want the H2036 HA HH on their claims. Create a code that just has the revenue codes you use and use those to submit to BCBS. Also, I would run a report to see where you have been short paid and have BCBS reprocess or send replacement claims for all so you can get your full payment.

Just curious what code did you use?  I found I could use H2036 HA and it appears BCBS is accepting.  

We just use 0945 or 0944. No HCPCS code or modifier.

Hi Sadie,

So can I bill 1002 and 0944 together on one claim?  

I use H2035 HA HQ with rev code 0944 or 0945 for OP CD group treatment and H2034 HA for OP individual treatment with either rev code and claims are being paid.