bcbs

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    Wiki BCBS Local Plan Question

    I work for an independent laboratory that has an ordering provider who straddles a state line. We're getting a bit of pushback regarding what would decide the local plan from the ordering provider because their NPI is registered in one state but the specimens are being ordered and obtained in...
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    Wiki BCBS Claim Rejections

    Hi guys! I am wondering if anyone can help me out. I am getting BCBS claim rejections for subscriber ID not found or invalid. All info has been triple checked. EDI says that they don't even have the claims. Our clearinghouse is stating the rejection is coming from the payer. I am at an absolute...
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    Wiki Adjustment Reason Code 107

    I am so confused on what this ARC means. This was sent back to me by Blue Care Network (part of BCBS of MI)... I billed a TCM (99496) and Medication Reconciliation (1111F). The claim was processed without payment due the following: CO-107: The related or qualifying claim/service was not...
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    Wiki G2212 not paying by BCBS

    Hi! I am newer to family practice, and I cannot get BCBS (of Colorado) to pay G2212? The denials state, "diagnosis code and procedure code combination that is not reimbursable." and "Missing/incomplete/invalid other diagnosis." I can't find anything that shows the dx's we use to be invalid with...
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    Wiki -SA Modifier

    Hi all! We have a scenario where the doctor wants to bill for the NP seeing the patient under his NPI with the -SA modifier even when he is not in the office at the time of the service. I know Medicare clearly states that the doctor must be in the office suite at the time of service but BCBS TX...
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    Wiki BCBS denying malignant excisions as benign?

    We have recently recieved an influx of denials on malignant excisions for basal cell carcinoma due to the fact that --according to BCBS-- BCC is considered benign "because it is unlikely to metastasize". There is a whole slew of things wrong with this statement, and with the implications on...
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    Wiki ESI 62321-62323

    Blue Cross claim denials when billing 62321 and 62323 together.
  8. kimmcelderry@gmail.com

    Wiki Insurance company refusing to take back overpayment

    Hi there, I have a patient with 2 BCBS policies. The secondary is a medicare advantage plan and has a higher allowable than the primary, so the claims are all overpaid. I called BCBS and they told me they "cant tell me how to run my books" and couldnt advise on what to do with the...
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    Wiki 99358

    We are billing 99358 to BCBS and Aetna medicare advantage plans and medicaid. They are denying this code. Is anyone else having this issue? Is there something we can be doing to get this paid? We are billing for nursing facilities. The providers review patient records before being seen in facility.
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    Wiki CPT 59866 POS

    Can cpt 59866( Multifetal Pregnancy Reduction(s) be billed with POS 11? I have a claim from BCBS denying stating POS is invalid.
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    Wiki CPT 33285

    Can someone please offer some knowledge on this cpt code. 33285. (This is for Professional claims) NY state(NYC) We have been billing Empire BCBS( Mainly mediblue) for this service both inpatient and outpatient. Under BCBS policy the dx that we have been billing Z86.73 or R55 are allowed per...
    • PatriciaR
    • Thread
    • bcbs bcbs denials billing cardiology
    • Replies: 1
    • Forum: Cardiology
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    Wiki BCBS Cross Coding Oral/Maxiollofacial Surgery (CPT to CDT)

    Hello everyone! My name is Mallory and I work as a coder/biller for an oral/maxiollofacial surgeon in Lee's Summit, MO. While the majority of our practice is dental related (wisdom teeth, jaw bone grafting, etc.) my physician also does trauma rounds at the hospital, sees patient's for oral...
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    Wiki Federal BCBS rejecting 62323 and 62321

    We have been having issues all of 2017 with FEP denying 62323 and 62321. First for medical records, and then when we send them, that our providers are not eligble to perform the service. 62311 and 62310 we never had any issues with nor are we having any issues with any of our other injection...
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    Wiki BCBS denying E/M codes with 25 modifier

    I do billing for five different practices across Texas and am having an issue with BCBS. They are denying most E/M codes when we use the 25-modifier (to distinguish from other services rendered the same day). I've gotten dozens of these so far. I have read some info online from different...
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    Wiki Modifier 59 on administration codes for injections.

    I work at a Primary Care office and recently have received multiple denials on BCBS claims with vaccine injections. I contacted BCBS and was told that the administration code 90471 (billed with modifier 59) that we use for flu and pneumonia vaccines has "expired as of November 20, 2017". She...
    • Lynnctodd
    • Thread
    • administration code bcbs modifier 59 modifier 59 denial
    • Replies: 2
    • Forum: Modifiers
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    Wiki Z80.0 clinical edit error BCBS Michigan

    Anyone experiencing denials for Z80.0 with BCBS? I've run into several plans that are denying Z80.0 (family hx colon cancer) as an invalid ICD10 code for high risk screening colonoscopy. I've talked with provider services, reported the issue and believe since Oct 1st they have an error in their...
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    Wiki BCBS FL denials for B20 (HIV)

    Is anyone else having an issue with BCBS of FL denials for diagnosis B20 (HIV)? They think that this is an inactive code as of 2017 - but I have checked CMS' site and CDC listing of ICD-10 and both show it as valid for this year with no planned addenda for the April 1st release either.
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    Wiki BCBS Medical Necessity Denial

    Hi All! Hoping someone can help me out. We have been put on prepayment review for BCBS which means we need to submit medical records for all codes billed with a Transvaginal sonogram. We have done so for all patients (2-3 page E&M, 2-3 page Ultrasound report). BCBS has constantly come back on...
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    Wiki Lab Services

    Does anyone in a Family Practice setting preform lab services? Do you draw the patient's blood and send it out to a particular lab to be tested & resulted to your office? If, you do my next question is are you getting paid for your services by BCBS of NC?
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    Wiki Cpt 99420 bcbs tn

    BCBS TN ask that we code our PAS Forms with 99420. We are submitting a recommended fee of $250.00 from them. We have a new provider who is doing the Drug/Alcohol Assessments and she has been told to use the 99420 as the code for the first two A's of the Five A's (Ask, Assess) in the Alcohol...
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    Wiki Bariatric Screening Lab?

    BCBS is denying our labs that we have ordered on our Bariatric patients due to not medically necessary. We order these to see if there are any comorbidities that the patient/physician isn't aware of. This really wouldn't be considered pre-operative lab work, as we haven't scheduled the surgery...
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    Wiki BCBS denials for duplication on Diabetic shoes

    I am new to the Podiatry billing and have been having difficulties getting our claims paid for Diabetic shoes, CPT A5512 with Modifiers KX, LT, RT & CPT A5500 with Modifiers KX, LT, RT. We usually bill for 2 pairs of shoes and 3 pairs of inserts; therefore, 2 units and 6 units. We have the...
    • cindyjj
    • Thread
    • bcbs modifiers pairs shoes units
    • Replies: 2
    • Forum: Modifiers
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    Wiki Appropriate code for billing UDS - BCBS and AETNA

    Hi all, Recently we are receiving denials from AETNA for 2016 claims as " Need to bill with appropriate HCPCS" , currently we are billing 8-series codes for confirmatory tests. The same issue for BCBS. Please help on the above cases as we need to bill HCPCS/CPT code for BCBS and AETNA...
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    Wiki 36415 and 99000 BCBS

    Can someone please tell me whether we are to bill both 36415 and 99000 to BCBS, or just the 99000? My trainer is telling me to only send 99000, but our patient account rep is saying I need to send both.
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    Wiki Bcbsnc, 99000 & 36415

    For the last few years we have been billing BCBSNC 99000 lab handling fee & 36415 venipuncture. BCBS would pay 99000 but deny 36415. In the last few months, both codes have been getting denied. I just found out that BCBS changed their Corporate Reimbursement Policy to say that 36415, 36416 &...
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    Wiki BCBS Glitches since ICD-10 implementation

    Just a question to see if anyone else is having issues getting paid by BCBS. Starting on 9/25, we have had a multitude of issues. For instance, there are several days in September that our claims were sent to BCBS electronically and accepted by the payer yet BCBS has no record of the claims...
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