Author Topic: Re: Third Party Negotiations for BCBS policies  (Read 19584 times)

seancongress

  • Newbie
  • *
  • Posts: 1
Re: Third Party Negotiations for BCBS policies
« on: November 15, 2023, 05:17:50 PM »
Hi there,

New to this forum. I run a Negotiations department in the billing company I work for. It's SA/MH, all LOC. We rake in a ton of money through negotiating additional payments for carriers like Cigna, UMR, etc and I'm very happy with that. With BCBS, it's different. For example, the EOB will have a remark "216=Based on the findings of a review organization". It's clear this was priced elsewhere but I'm having trouble finding this out. I've called our local (FL Blue) multiple times and I would truly rather chew glass than call again.

Additionally, I had a claim whose DOS were pulling up on Data iSight's portal. Two days of calling FL Blue and all I got was the old spiel of "reimbursement is based on the allowed amount" as if this is some revelation, when in fact, I have proof it was priced through them. Does anyone have any experience dealing with negotiating additional payments for BCBS? It is a code I am tracking to crack. Thank you!

Nick D

  • Newbie
  • *
  • Posts: 40
Re: Third Party Negotiations for BCBS policies
« Reply #1 on: December 26, 2023, 07:22:13 PM »
You're on the right track, Sean. Especially Anthems. They will pull in the DiS portal but you need to follow the appeal process to get them to open. Much like Cigna and their "stand-ons".
OON Facilities Billing Manager

Medical Billing Forum

Re: Third Party Negotiations for BCBS policies
« Reply #1 on: December 26, 2023, 07:22:13 PM »