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Insurance Payments / Re: Third Party Negotiations for BCBS policies
« Last post by seancongress 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!
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