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Denials from BCBS PMAP for Clinical Documentation?

vpetrik 9 months ago in Payments/ERA Modules updated by sarah 9 months ago 1

Hello!,

We recently received rejected claims from BCBS PMAP for not having clinical documentation sent to the claims department. We have never encountered this problem before. I was told by a representative that I we needed to submit clinical for authorization AND to the Billing/Claiims department at BCBS? Has anyone else run into this issue? I was told by the representative that I can submit this information through Availity, although she couldn't tell me how? If anyone has any suggestions or comments, I would great appreciate it! We are billing for CD treatment residential treatment services. Thank you!

I have not heard that Availity has the authorization portion updated and operational, yet. It would be nice if they did. We have had some requests for documentation for clients in our DBT program. It will be one random DOS - when they have paid the four before and after the DOS requested. They are still processing those, but someone in the claims call center assured me the service line would be paid - I just have to wait 45 days. I have been faxing the requested documents, for now.