Author Topic: BCBS Problems  (Read 1310 times)

rballinger1

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BCBS Problems
« on: October 04, 2016, 09:03:24 PM »
We are receiving claims back from BCBS stating the ICD P Code is invalid for the billing provider.  The ASC is located in Georgia.  BCBS of GA has always required we place the CPT Code in Box(es) 74 a, b, c, d, etc.  Recently the provider relations representative informed our office that we should leave Box 74 empty.  Is anyone else had this problem?  How are other ASCs billing for Box 74?

Does anyone have a problem getting the diagnosis qualifier to print in box 66?  We have issues with a laser printer printing that close to the margin.  We have also been told by BCBS to use the qualifier "0", but I read somewhere else that it should be "10", any suggestions?

Michele

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Re: BCBS Problems
« Reply #1 on: October 05, 2016, 01:12:19 PM »
I am not currently billing for any ASCs so I haven't seen this problem.  But I have seen that sometimes certain insurance carriers will require something different than the norm.  If they are telling you to leave it blank I would try that. 

We have not had any issue getting the dx version qualifier to print.  We use '0' for ICD 10.

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rballinger1

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Re: BCBS Problems
« Reply #2 on: October 08, 2016, 05:53:09 PM »
Thank you Michelle.  It's strange that payors cannot all accept the same standard format,  We've all gone out of our way to meet the HIPAA and ICD-10 compliance measures yet payors still have different requirements.  So much for a standardized system.

Michele

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Re: BCBS Problems
« Reply #3 on: October 10, 2016, 07:31:45 AM »
One thing I have learned in 23 years is that you have to be flexible.  Things are always changing and not all insurance carriers want this the same.  It certainly can be very frustrating!
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cpapsadora

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Re: BCBS Problems
« Reply #4 on: December 22, 2016, 09:17:08 AM »
Good Morning,

We are receiving claims back from BCBS due to incomplete information in the value codes area 39-41.  We bill BCBS for clients who have been treated at our crisis stabilization unit that is licensed as a Residential facility thru the State of Maine.  The type of bill I use is 861, rev code 1001, CPT code of S9485.  We have never used value codes on any of claims and we are lost as to how to complete the value code information on the UB04.  Can you give us any assistance on this?  Thank you, Charlene

Michele

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Re: BCBS Problems
« Reply #5 on: December 22, 2016, 11:39:04 AM »
Is the patient in a semi-private room?  There is a value code of "01" for "most common semiprivate room rate".  But, I would call first to make sure that you completely understand the denial to make sure you are correcting the right issue.

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cpapsadora

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Re: BCBS Problems
« Reply #6 on: December 22, 2016, 01:21:32 PM »
all of our rooms are private as these children are dealing with crisis issues.  I will call Anthem again and try to get some answers but I really am unsure what I should be asking.  You replied to have them explain fully the denial reasons.  I'll try that and see how I make out.  Thank you....