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BCBS Denial

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MacCG:
Hi, I work in a counseling office and submit mental health outpatient claims.   This is the first time I've ever had a denial come back from BCBS with the explanation of denial *Benefit Covered only if provided or ordered by primary care physician or medical group.    Any suggestions?  I have a hard time actually speaking with a customer representative because I keep getting the automated system.   Any help is greatly appreciated!

Michele:
Sounds like an authorization or referral is needed and is absent.  Do you have auth or a referral?  If so, I would resubmit with that information.

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