Author Topic: Out of Network w/ Primary, In Network w/ Secondary  (Read 214 times)

madisonrm

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Out of Network w/ Primary, In Network w/ Secondary
« on: June 11, 2021, 04:08:55 PM »
We have a patient coming in for a diagnostic hearing test. They have Cigna primary and BCBS secondary. We are out of network with Cigna, but in network with BCBS. Can I bill Cigna first, knowing that we are out of network, and will they forward to BCBS as secondary? Or will they deny it right away because we're out of network?
Or can I just go straight to BCBS?
Thanks in advance!

Michele

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Re: Out of Network w/ Primary, In Network w/ Secondary
« Reply #1 on: June 12, 2021, 03:21:23 PM »
You definitely need to bill Cigna first.  BCBS won't process without the Cigna EOB.  Even though you are out of network, Cigna will process the claim.  They will not forward it directly to BCBS though.  You will have to do that manually with a copy of the Cigna eob, or thru your clearinghouse if you can, with the primary EOB information on the claim.
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Re: Out of Network w/ Primary, In Network w/ Secondary
« Reply #1 on: June 12, 2021, 03:21:23 PM »