Payments > Insurance Payments
BCBS MN is being HORRIBLE, anyone have contact info?
shanbull:
I will try not to write a novel here but it's a drawn-out issue. Basically, we never received remittance for 7 payments from BCBS MN during a 2 month time span during which we changed the clearinghouse and vendor for our EDI files. Neither the previous nor current clearinghouse received these files.
BCBS MN directs me to use Availity to find these files. When I attempt to do so, I get a message that states "The ERA must have been delivered to Availity." We do not use Availity to receive this information so it was not delivered to us through Availity.
So back to square one, I called the BCBS MN call center and was told I would be transferred to "claims" and was hung up on. I tried again, same thing. I called the technical support line, which transferred me to the provider call center, and the same thing happened all over again.
At this point I mailed a letter on May 16th detailing the problem and my attempts to communicate with various sources to get this information, with all of the relevant info on the missing remittance and my contact information. I have not received a response. (edit: apparently I did receive a response, they told me it was my responsibility to track down the remittance)
Today I called the technical support line again and was transferred to a number with an endless loop telling me I could press 0 to speak to a representative, then when I pressed 0 it would say I had chosen an invalid selection and repeat the message saying I could press 0 to talk to a representative. If I call the provider call center directly I can talk to a human, but they have nothing to do with this and can only give me claim-specific information, and transferring my call causes the hangup to happen.
I'm at a loss. Unable to find contact information for a higher-up representative and the provider call center won't give it to me. Anyone have contact info, or suggestions on what I can do next? This is getting to be absurd.
PMRNC:
Can you just call and get copies of the original EOB's?
I'm assuming these are paid claims since you said
--- Quote ---we never received remittance for 7 payments from BCBS MN during a 2 month time span
--- End quote ---
If you have auto posting I do understand you'll have to manually post these if it wasn't done auto.
shanbull:
--- Quote from: PMRNC on June 06, 2014, 04:10:18 PM ---Can you just call and get copies of the original EOB's?
I'm assuming these are paid claims since you said
--- Quote ---we never received remittance for 7 payments from BCBS MN during a 2 month time span
--- End quote ---
If you have auto posting I do understand you'll have to manually post these if it wasn't done auto.
--- End quote ---
At least some were paid, we did receive the EFT's. It is illegal for BCBS MN to send the remittance via paper in Minnesota (there are exceptions but apparently they don't care to look into it further) and they will not have anything to do with EDI transactions. They have completely transferred EDI to Availity and apparently do not have any support for it within BCBS MN. I have contacted Availity as my last hope, but I am doubtful that BCBS MN sent them the full 835 files. It's just a mess.
DMK:
Since it's BC BS could you go to the Blue Shield site for the EOB'S? If the timeline was prior to the hard change to Availity, could you go to the Blue Cross site?
I'm not a big fan of Availity myself. We keep running into pre-authorization requirements that are not posted anywhere on Availity. And the ACA program coverage lists are bogus.
I hate to throw gasoline on the ongoing offshore issue, but it's really frustrating to have to do the phone merry-go-round with foreign operators.
I know it's a money saver for the insurance companies, but wouldn't it be more cost effective to make it fast and easy?
shanbull:
The hard change was actually from Zirmed/Medisoft to Emdeon/eClinicalWorks, no Availity involved. Which makes this even more confusing. And the BCBS MN website just says "Online self-service via Availity. Go to Availity.com ExternalLink for eligibility/benefit inquiry, claim status inquiry, claim submission and remittance advice. To create, update and view referrals and admission notifications, access Availity.com through External Resources/PWSS." Here's where it says that: https://www.bluecrossmn.com/Page/mn/en_US/provider-self-service If you click "sign in" and select the provider option it just keeps bringing you to this page.
There is no portal at all on the BCBS MN website to access this information. And Availity only has the 835 files if the ERA's were delivered to us by Availity. Insane right? The most I can do is look up individual claims, but we have only a vague idea of which claims are the ones involved in these missing payments and going claim by claim would be very time consuming. If we absolutely have to this might be the only option :-\
Edit: Sorry, I also meant to clarify that Blue Cross and Blue Shield is one consolidated entity in Minnesota. I know they are still separate in some states but here it's just the one company.
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