General Category > General Questions
fee schedules
PMRNC:
--- Quote ---Is it something in the water??? I have been dealing with BCBS regarding a patient claim dated 12/03/08 we billed out 24,188.00 The claim was split and there was another claim of 3699.00 BCBS had issues with the NU modifier on the e1010 and the e2377. They kept doing something with the claim and they "duplicated it" there was a claim in the system for 48,376.00 Well they paid 36K on the claim!! They had just paid on the smaller one of 3699.000 Regretfully we have to send about 18K back to BCBS :-(
--- End quote ---
Can't explain the error but I know when i processed DME claims they did have to get split into multiple claims if the claims examiners payment threshold was too low (we used to like those for production.. lol)
But wow to get overpaid by BCBS.. good job.. LOL ::)
Pay_My_Claims:
Yes we split them because they will hold up a claim over a k0108 or since BCBS doesn't have a complete dme fee schedule they will hold for other codes, so we split our claim. :-) This was a technical issue on BCBS part for not recognizing the NU modifier!!! I was so tired of calling them about this claim I deserve the extra money..LOL, but I know it has to go back or well you already know.......
Charles:
Does this have any relation to the co-45 or pr 45 in respect to each contract?
Thanks
Michele:
I don't know what you mean by CO-45 or pr 45. Those sound like Medicare denials.
Pay_My_Claims:
--- Quote from: Michele on August 05, 2009, 12:06:06 AM ---I don't know what you mean by CO-45 or pr 45. Those sound like Medicare denials.
--- End quote ---
They are Medicare codes, co =contractual obligation and pr=patient responsibility
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