Author Topic: BCBS FL - Not covering 0914 and 0915 rev code - Substance abuse facility  (Read 1103 times)

npitaxid

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Hi guys,

So I just started billing again after an outside billing company had been billing for a year. Florida Blue had stopped paying for any claims like 90853 or 90834 with a revenue code of 0914 or 0915. They say that you have to bill on a HCFA even though we are a substance abuse facility. When I tried to submit on a HCFA it will reject. I called to see what to do and was told we needed a 5 digit provider number to submit on a HCFA. They told me in order to do this we would first need to add a taxonomy code of clinic/Group to our NPI and for it to not mention substance abuse in any way. They told me after this that I would be able to create a "non physicians, physicians group" through Availity that would be able to get me the 5 digit provider number in order to submit these claims on a HCFA. This seems ridiculous to me and doesn't feel like this is the right way to do it as we are a FACILITY. Can someone shed some light on this if you have any knowledge, I'm completely lost :(

Michele

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Re: BCBS FL - Not covering 0914 and 0915 rev code - Substance abuse facility
« Reply #1 on: September 27, 2016, 07:28:30 PM »
Were you getting paid previously?  It seems odd if you were being paid but now you are not.  Is there a provider rep you can check with?
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npitaxid

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Re: BCBS FL - Not covering 0914 and 0915 rev code - Substance abuse facility
« Reply #2 on: September 28, 2016, 07:40:41 AM »
So I was told that BCBS policy had changed I believe 1/1/16 and that facilities could not bill for 0914 or 0915. When that happened all of our routine outpatient services with those revenue codes started to deny or just reject. So our Outpatient Group therapy, individual and psych all denied. We are out of network and I have spoken with 3 reps who said we need to do what I had listed previously. One of my coworkers said at her old facility she was told to use 0906 (IOP) for OP group claims and 0912 (PHP) for individuals and they were getting paid. I don't agree with this though, why would you use a revenue code that indicates partial hospitalization for an Outpatient group claim? I feel like if BCBS were to audit our account they would recoup that money for incorrect billing.

Michele

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Re: BCBS FL - Not covering 0914 and 0915 rev code - Substance abuse facility
« Reply #3 on: September 28, 2016, 08:23:20 AM »
It sounds to me like they are saying that the provider is not in network.  BCBS of FL requires that providers get a BCBS provider number and that is what it sounds like they are telling you to do.  Must be that the provider was ok to bill as a facility but not ok to bill as a professional provider.  So it looks like that is what you need to do.  I'm really just guessing based on your information and experience that we have had with credentialing FL providers and billing for a few as well.  BCBS of FL is a bit different than our local BCBS and many other BCBSs that we have dealt with. 
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npitaxid

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Re: BCBS FL - Not covering 0914 and 0915 rev code - Substance abuse facility
« Reply #4 on: September 28, 2016, 08:43:32 AM »
So we do have a BCBS provider number to submit claims which is only 3 digits but they automatically provide the 3 digit number when you register as a facility. They are telling me we need a 5 digit one which you can only get if you sign up as a physicians group. This is definitely and unusual situation, I'll keep calling them to see if I can get any more info.
Yeah I think FL Blue is the only one that is having this issue :/

Michele

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Re: BCBS FL - Not covering 0914 and 0915 rev code - Substance abuse facility
« Reply #5 on: September 29, 2016, 07:54:07 AM »
Sounds like they have separate enrollment for facilities and professional providers so they were enrolled as a facility but now that they are requiring them to bill as a professional instead of facility.  So they have to get that five digit provider number in order to do that.  That's the thing with this line of work, things are constantly changing.  Especially insurance carriers!
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