Author Topic: BCBS nor forwarding claims  (Read 1664 times)

midwifebiller

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BCBS nor forwarding claims
« on: June 03, 2010, 11:34:53 PM »
BCBS of SC does not reimburse midwives, but most other out-of-state BCBS plans do.  So, for our SC midwives, I send claims to BCBS of SC so they can forward them to the out-of-state plan. The problem is, they refuse to forward claims. They return our paper claims, and reject any e-claims we send.  I have tried sending directly to the out-of-state plan with an explanation, but they insist claims must come through the local plan. I have spoken to the Medical Director twice about the problem and he just says it's a "system glitch" that they are working on (and have been for 2+ years now).  Any ideas as to what my next step should be?

~Kelli Sugihara
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com

Michele

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Re: BCBS nor forwarding claims
« Reply #1 on: June 04, 2010, 07:32:51 AM »
I would ask the medical director for a contact at BCBS that you can send the paper claims directly to so they are not returned.  All claims, in or out of network are supposed to be sent to your local, which is what you are attempting to do.  If they have a 'system glitch' then they should offer you an alternative.  Someone who understands the situation and that can receive the claims directly and route them properly so that they are not returned.

Our local BCBS has had a 'system glitch' for over 5 yrs now (not the same issue as yours, ours involves a modifier).  We send all claims involving this glitch to a certain rep and they are hand processed.  It took us some time to get it set up, but it works out well now.

Michele
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midwifebiller

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Re: BCBS nor forwarding claims
« Reply #2 on: June 04, 2010, 09:56:31 AM »
Michele,

Thank you for the advice.  I called BCBS first thing this morning, the Medical Director has been promoted to VP, so at the moment they have no Medical Director for me to speak with.  A supervisor is looking into the situation and is supposed to call me back today, so we'll see.

I have also printed out the complaint form from the SC OIC website.  Hopefully I won't have to use it...

~Kelli
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com

midwifebiller

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Re: BCBS not forwarding claims
« Reply #3 on: June 04, 2010, 09:57:25 AM »
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Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com

midwifebiller

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Re: BCBS nor forwarding claims
« Reply #4 on: June 19, 2010, 08:54:13 PM »
To follow-up, BCBS did contact me and we are working out a way to be sure claims are forwarded.  Thank you for your input.
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com