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Has anyone received denials from Blue Plus PMAP for 2019 dates for an authorization?

Tina B 1 jaar geleden in Payments/ERA Modules bijgewerkt door Karen H 1 jaar geleden 23

I received denials for 90791-90834-90837 and our group and IOP codes for an auth. I checked on the BCBS provider site and at first it appears behavioral health may need an auth, but non of the codes are on the prior authorization list.

Thanks....Tina

Antwoord

Antwoord

Hi Tina, 

Information will be going up on our new "Updates" page regarding this. We have a fix in place, as we were made aware of this issue this morning. 

Please stay tuned, the update will be posted shortly. 

Thank you, 

Amanda

Antwoord

Hi Tina, 

Information will be going up on our new "Updates" page regarding this. We have a fix in place, as we were made aware of this issue this morning. 

Please stay tuned, the update will be posted shortly. 

Thank you, 

Amanda

We have the same issue!  One of our billers called BCBS and they said it ooked like a Wisconsin provider (which it is NOT) and they could not tell us where they were 'seeing' that either.  The PMAP was processed through the commercial plan as far as we can tell - the remit was from the commercial BC instead of the PMAP.  They were also denying as needing an auth.  Put in a ticket with Procentive to see if other providers have this issue and to make sure it is not a payer ID glitch.

Yes, We have the same issue.

  1. Blue plus claims have denials within the BCBS Commercial Remit.
  2. Denial states services need Auths 

Yes, we had denials on BCBS Commerical Remit, only because our Electronic Payer ID for Blue Plus PMAP 01/01/2019 was not updated to the new payer id and it was sent to the old BCBS PMAP 12/31/2018 electronic id SB720.  So it was processed with the commercial plans.   I ended up resubmitted the claim to the new payer.

Hope that makes sense.  

Received a ton of denials from Blue Plus PMAP that are going to the new correct electronic payer that are denying for prior auth needed.  Are others still getting this denial and is there a fix in place for it?  What a nightmare!

Hi,

Yes. Global denials. We called Amerigroup. We were advised -  There were a large batch of claims that processed incorrectly due to a configuration error on THEIR end. They labeled these claims as out of state. They are aware and are correcting and reprocessing these claims.

If claims were sent to correct new Payer ID for BCBS PMAP and we get denials for needing an auth, is the fix to resend them as NEW claims, or a corrected claim? What have you done? Any luck?

I contacted BP yesterday and they said it is an on their end.  All claims would be reprocessed.  We don't have to refile.

I just called BCBS PMAP new # and the rep said that it's recommended that we contact the clearing house (which Procentive does that for us) to be sure that they have fixed the issue with the claims being routed or showing up as out of state. She said I would have to resend all of the claims, that they would not reprocess them.

Classic--different responses from the same call center! 

Has anyone received payment form PMAP 2019 claims yet? If so, did you resend denied claims as new claims? Or is it because you sent them after 1/14 like Procentive said?

All claims are denying for me.

+1

They denied for me as well and that is why I contacted BCBS/BP.  I don't understand why we can get some many different answers from the same call center.  I think I will contact them again just to verify that claims do or do not have to be resubmitted.

We have not yet received payment, and I resent claims 1/14/19 as instructed.  

We have not received any payment from BP yet but as Karen stated above I believe they are still reprocessing.

Possibly Procentive is connecting with the Availity on this issue to ensure compliance.

Has anyone receive dpayment on BluePlus charges from dates of service in 2019?  I have even tried to look them up in Availity and it says the ID is incorrect on the claims & Payments even when I pick BluePlus.  Has anyone else found out where we can find these payements?

When you check for the new ID. numbers for 2019 on Availity, use the client's name and DOB.  That is how we are getting the new ID. numbers.  Make sure you pick the BCBS/Medicaid payer.  As far as the authorizations go, I was informed by BCBC/BP that those claims will be reprocessed.  Hope that helps.

I just got off the phone with BluePlus.  Yes I knew where to go to look up the id.  I was looking for claim and payment status on Availity like you can see with the other payers.  Blueplus said they were not reprocessing claims because they never received the original claims the issue was Availity as they had to up date their line of service.  Anything prior to 1/16 needs to be resent is what the customer service manager said when I called.

Still no Blue Plus Payments. This really hurts financially

Hi Tina,

No payments from BCBS PMAP (Amerigroup) today either. We need to allow more time, unfortunately. It does impact the A/R significantly.

Debbie

I've also noticed this new payer is not showing up on the eligibility list when verifying clients insurance.

I spoke with a Michelle this afternoon as some claims are denying as CO 109.  She said that BCBS thinks that the services are being provided outside of MN.  Two of my claims are being reviewed now.  I asked again about the authorization denials and she said she is seeing some of those come through again and are paying.

There is a News and Announcements out on Availty when you log in. Scroll down on the main page and the second bulletin gives 4 pages of issues with different BluePlus issues.  It addresses auths and claims that were being denied that we need to resubmit after a certain date any claims prior.

Has anyone received payments from BCBS PMAPS for services in January?