Author Topic: BCBS MN is being HORRIBLE, anyone have contact info?  (Read 3740 times)

shanbull

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BCBS MN is being HORRIBLE, anyone have contact info?
« on: June 06, 2014, 01:05:46 PM »
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.
« Last Edit: June 06, 2014, 01:07:53 PM by shanbull »

PMRNC

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Re: BCBS MN is being HORRIBLE, anyone have contact info?
« Reply #1 on: June 06, 2014, 01:10:18 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

If you have auto posting I do understand you'll have to manually post these if it wasn't done auto.
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shanbull

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Re: BCBS MN is being HORRIBLE, anyone have contact info?
« Reply #2 on: June 06, 2014, 01:24:43 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

If you have auto posting I do understand you'll have to manually post these if it wasn't done auto.

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.
« Last Edit: June 06, 2014, 01:27:46 PM by shanbull »

DMK

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Re: BCBS MN is being HORRIBLE, anyone have contact info?
« Reply #3 on: June 06, 2014, 01:33:15 PM »
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

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Re: BCBS MN is being HORRIBLE, anyone have contact info?
« Reply #4 on: June 06, 2014, 02:45:07 PM »
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.
« Last Edit: June 06, 2014, 02:51:53 PM by shanbull »

Michele

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Re: BCBS MN is being HORRIBLE, anyone have contact info?
« Reply #5 on: June 09, 2014, 02:31:03 PM »
Do you have a provider rep?  We have provider reps for our local BCBS and they usually can help us with any situation such as this.
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shanbull

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Re: BCBS MN is being HORRIBLE, anyone have contact info?
« Reply #6 on: June 09, 2014, 03:09:10 PM »
Do you have a provider rep?  We have provider reps for our local BCBS and they usually can help us with any situation such as this.

Nope, and they will not give us any contact info for one at the provider call center when we ask.

I decided to file a complaint with the BBB because they have made it so hard to reach anyone who can help. I asked them to add network rep contact information to their website, at the very least. There are serious issues with their corporate structure, given that I had to do this to get in contact with someone who isn't an entry-level call center employee. I mean if I were the CEO, I would make darn sure the providers can contact the company without having to resort to a third party organization.

PMRNC

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Re: BCBS MN is being HORRIBLE, anyone have contact info?
« Reply #7 on: June 09, 2014, 04:37:41 PM »
The BBB really can't do anything, they are not a regulatory company. Here's what you have to do. Compile all the claims that are ERISA, ERISA claims are the responsibility of the patient in the end.. REGARDLESS of assignment of benefits OR network contracts. ERISA is overseen by the US Dept of Labor, you have get the patients/insured involved. If they refuse or are not cooperative, send them a bill and a letter explaining the situation, they will call :)
For NON ERISA claims you need to file a complaint with the Dept of Insurance for the your state.
Linda Walker
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shanbull

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Re: BCBS MN is being HORRIBLE, anyone have contact info?
« Reply #8 on: June 09, 2014, 05:24:48 PM »
Thanks Linda, fortunately I was able to find a workaround with Availity. We could only download the payment info claim by claim but we'll take anything we can get at this point. I still can't believe it was such a hassle and may still file a complaint because I can see this happening again.

Mazie

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Re: BCBS MN is being HORRIBLE, anyone have contact info?
« Reply #9 on: August 12, 2015, 08:13:42 PM »
I will try not to write a novel here but it's a drawn-out issue.

This is what it is like dealing with Humana in 2015.