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BCBS denial codes

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Chiro Billing Collect:
Re: Chiropractic billing

BCBS just recently started denying modalities (mainly 97012 and 97140) stating that: QJB - We cannot pay for this service due to a contractual agreement with the provider for this procedure and B15 - This service/procedure requires that a qualifying service/procedure be received and covered.

These are services that were always payable under the provider's contract and now about 85% of the claims come back with those denial codes for the modalities.

I was wondering if anyone had any insight? I thought they may have recently started to require the GP modifiers as UHC does but I am at a loss.

Thank you in advance.

Michele:
Is it all BC plans across the board?  Or just Medicare Advantage plans?  Have you called and spoke to anyone?  I would start with my provider rep, if you have one.  They should be able to point you to a bulletin, or something to explain the sudden denials.

Chiro Billing Collect:
Thank you for your reply. Yes, it is all across the board for BCBS plans. I have tried to request reconsideration and they come back stating they were paid correctly. I don't think we have a provider rep but hope that by calling multiple times there will be a claims rep that can offer some guidance.

Michele:
If you don't have a provider rep I would definitely call and speak to a claims rep.  They really should be able to point you to documentation if it was being covered but now it's not.

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