Billing > Facility Billing

BCBSM asking pt for UB-04 after submitting reimburstment superbill from hospital


Patient had MRI and PET services performed out of state with an in-network provider according to their plan due to lack of proper PA at time of diagnostic imaging services.

At the time of services, the patient didn't have required PAs from their plan and patient paid out of pocket for services. The billing team generated a statement for insurance reimbursement for the patient with services, CPT/HSCPS codes, and the cost and amount(s) paid. BCBS sent a letter to the patient requesting a UB-04 form however we never processed their services directly to their insurance as they paid privately due to conflicts obtaining prior authorization.

What's missing to have their reimbursement claim processed for an in-network provider, but when patient paid directly for services. We don't have a UB-04 form for this date of service on the patient, and don't want to delay  reimbursement.


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