Author Topic: BCBS not paying for 6 months  (Read 2143 times)

barb2512

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BCBS not paying for 6 months
« on: May 07, 2014, 07:52:48 PM »
Provider I bill for is having trouble getting claims with a certain alpha prefix processed. BCBS admits the problem is their system. I have copied below an email I received today. How do we charge interest or penalties for their system error? We have easily $2000 tied up in payments we are waiting on. And if they don't fix this till June it will be up to $2750.

Barbara,

We were given the date that a fix to the system would have been 4/26/14, we were advised on 5/2/14 that the fix to the system is slated to go in for a 6/8/14 release date.   Once this is in place, we have a special team that will pull all claims going back to January and have them reprocess based on your PPO contract and the members benefit.  The team has tried manually adjustments  and even those are not working.   
Thank you,
Paula Kler
Northeast Texas Provider Relations

Any help is appreciated.
Thank you,
Barbara

PMRNC

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Re: BCBS not paying for 6 months
« Reply #1 on: May 08, 2014, 07:55:58 AM »
You can't arbitrarily add on interest or penalties. If the policy is goverened by state insurance dept you would go by state laws for collecting interest from late payments from carriers. If the Policy is an ERISA plan, ERISA laws would pre-empt those laws that pertain to benefits, payment of claims from providers is not a benefit issue and providers are not plan participants.
Linda Walker
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Michele

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Re: BCBS not paying for 6 months
« Reply #2 on: May 08, 2014, 08:40:47 AM »
We have had similar issues with our local BCBS for certain plans.  The issues have been ongoing for years now actually.  We are told it is not a high priority for them to fix.  It's a system issue and they are only allowed to address so many system issues in a period.  Ours keeps getting bumped for issues with a higher priority.  Our drs have way more than $2000 tied up and our hands are tied.  They do eventually correct all of the issues manually but it is so time consuming on our end keeping track of what needs to be fixed.  It's just part of the game.
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kristin

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Re: BCBS not paying for 6 months
« Reply #3 on: May 08, 2014, 08:58:17 PM »
Here in the state of Illinois, which is "broke", any of our patients who are active state employees or retirees with pension insurance through the state as their secondary get their claims paid when there is money to pay them. I have claims going back to late 2012 that still aren't paid, but when the payments do come, there is always an extra check for the interest that has accrued on the payment. I probably have somewhere in the neighborhood of $2000 still out there, and at the highest point, it was around $5000, before payments started trickling in. So yeah, it stinks, but you can't get blood from a stone, as they say.

shanbull

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Re: BCBS not paying for 6 months
« Reply #4 on: May 09, 2014, 09:51:20 AM »
We have a lot of injury cases that sometimes take 5+ years to get figured out in court so we get paid. Just make sure you have excellent records of when claims were submitted and all follow-up attempts. BCBS knows that it will owe interest. Just bug them every so often about the unpaid claims. Beyond finding higher-ups to complain to (doing this to enough people over time tends to get your issue prioritized so they don't have to hear from you), that's all you can really do.

PMRNC

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Re: BCBS not paying for 6 months
« Reply #5 on: May 09, 2014, 12:48:40 PM »
Just want to remind folks that "prompt pay" and "interest" carriers have to pay do NOT apply to ERISA based plans. Remember that more than 80% of claims are ERISA claims. ERISA follows FEDERAL laws and will ONLY acknowledge the patient/insured.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com