General Category > General Questions

Need clarification on BCBS par plan

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Pay_My_Claims:

--- Quote from: PMRNC on July 14, 2009, 06:24:54 PM ---BCBS will not honor assignment of benefits for non par providers. There might be one or two states that were challenging this but I'm not sure about the status of that.

--- End quote ---

BCBS OF NORTH CAROLINA Will not pay to the provider if you are non-par and as Linda stated will not honor the aob. It's not as bothersome if you have small claims, but I am now in pursuit of a claim payment sent to a client in excess of $28,000. We have 2 payments (just 2 clients) that are $37,000 both BCBS of NC. If it is the State plan, they will send payments (go figure), but the PPO, and Fed plans don't.

My receivables for this DME provider is high anyway. Wednesday I posted 82,000, Friday was 36,000 and Monday was 110,000. Today (whew-just notification of about 50k that has been cut to pay thus far). Doing my daily job, and having to chase a client for a check, is overwhelming at time. I wish BCBS of NC would open the panel for new DME providers.

PMRNC:
Charlene, Can you have the patients sign an ROR? That would obligate the patient to sign the check over to you guys. There are a few state guidelines you have to check to do this but ask your client to consult with their attorney for a good formatted ROR (Right of Recovery)  A good friend of my dad's is a surgeon and he uses this for high dollar claims BECAUSE of BCBS.

Pay_My_Claims:

--- Quote from: PMRNC on July 14, 2009, 10:35:45 PM ---Charlene, Can you have the patients sign an ROR? That would obligate the patient to sign the check over to you guys. There are a few state guidelines you have to check to do this but ask your client to consult with their attorney for a good formatted ROR (Right of Recovery)  A good friend of my dad's is a surgeon and he uses this for high dollar claims BECAUSE of BCBS.

--- End quote ---

Hey, Thanks, I didn't even think of that!

PMRNC:
I didn't either it just hit me because you have mentioned this before!  It's worth looking into :)

SamatNMBS:
Does anyone have a Right of Recovery letter they can share?

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