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BCBS Blue Plus Assessements

Jeremy Roelofs-Lynch 2 months ago in Payments/ERA Modules updated by Kim Ross 2 months ago 6

BCBS posted a Provider Bulliten on 4/10/2019 stating that as of 5/1/2019 we should bill the R25 Assessment with the HF Modifier to distinguuish between it and the Comprehensive Assessment. 

Yesterday we received two ERAs for DOS January - April 2019 where they reprocessed ALL of our R25's as Comps since they were billed with no HF Modifier. The communication I have clearly states it went into effect on 5/1/2019. We get paid more for our R25 so it is resulting in a large takeback.

Thoughts?

Jeremy

We have always had to call the provider line to ask for claims to be corrected.  I get a reference number along with the representative I spoke with and contact our contract representative with all the information.  He is able to help us resolve most issues we are having.

Thank you Jen. I have struggled to find out who our Contract Rep is. When I try to call and ask I am getting the run around. Any tips?

How much more does BCBS PMAP reimburse for a Rule 25?

It depends on your contracted rate with BCBS.  

Hi, we are (were?) contracted at a different rate. Now they are paying the 162.24 (lower than contracted rate) out of no where.....

How do you manage interns who have dual pre-licensure? We've noticed that staff with dual pre-licensure billing with an NPI for a PsyD supervisor pay higher than a single pre-license whose billing NPI is a Master's Level supervisor. We just requested our fee schedule and are trying to decode it...