Medical Billing Forum
Billing => Billing => : Chiro Billing Collect November 18, 2020, 05:45:13 PM
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Re: Chiropractic billing
BCBS just recently started denying modalities (mainly 97012 and 97140) stating that: QJB - We cannot pay for this service due to a contractual agreement with the provider for this procedure and B15 - This service/procedure requires that a qualifying service/procedure be received and covered.
These are services that were always payable under the provider's contract and now about 85% of the claims come back with those denial codes for the modalities.
I was wondering if anyone had any insight? I thought they may have recently started to require the GP modifiers as UHC does but I am at a loss.
Thank you in advance.
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Is it all BC plans across the board? Or just Medicare Advantage plans? Have you called and spoke to anyone? I would start with my provider rep, if you have one. They should be able to point you to a bulletin, or something to explain the sudden denials.
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Thank you for your reply. Yes, it is all across the board for BCBS plans. I have tried to request reconsideration and they come back stating they were paid correctly. I don't think we have a provider rep but hope that by calling multiple times there will be a claims rep that can offer some guidance.
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If you don't have a provider rep I would definitely call and speak to a claims rep. They really should be able to point you to documentation if it was being covered but now it's not.