Medical Billing Forum

Billing => Facility Billing => Topic started by: billingmom on August 17, 2012, 04:16:47 PM

Title: Billing Question
Post by: billingmom on August 17, 2012, 04:16:47 PM
I bill for facility charges using revenue codes.  Blue Cross Blue Shield of Florida is giving me a hard time.   Patients policy says no auth needed for outpatient services.  They keep denying the claims stating auth needed although i have spoken to them 4 times and confirmed no auth needed.  I billed 0906 rev code with a bill type of 131.    Any help will be greatly aprreciated.   Pt is receiving outpatient chemical dependency treatment.   They are saying that rev code needs an auth.  I dont know what other rev code i can use for out patient services.
Title: Re: Billing Question
Post by: Michele on August 18, 2012, 06:52:26 AM
This sounds like a tough situation.  You could file an appeal if you have something in writing stating that the patient's policy doesn't require auth for outpatient services.  The only other recommendation is to see if there is a provider rep for your area and work thru them.  That is what we do with our local BCBS when we have that type of issue.
Title: Re: Billing Question
Post by: PMRNC on August 18, 2012, 07:46:48 AM
With chemical dependency treatment, outpatient or inpatient USUALLY does indeed require an auth and BCBS usually has a third party do those. I've not seen many plans that do NOT require an auth. You might want to see if in your appeal you can request a retro auth based on the conditions that they told you one was not required. It's worth a shot anyway.
Title: Re: Billing Question
Post by: Michele on August 20, 2012, 06:36:23 AM
You know I have to agree with Linda.  I've billed outpatient chemical dependency on UB's to BC and it also usually had auth.
Title: Re: Billing Question
Post by: billingmom on August 22, 2012, 11:35:09 AM
I understand, but they told me bcbs changed their policy for out patient treatment, but i dont have it in writing.
Title: Re: Billing Question
Post by: PMRNC on August 22, 2012, 12:07:31 PM
unfortunately if it's not in writing it's not official. That's why carriers use the disclaimer when you call.