Wiki BCBS Glitches since ICD-10 implementation

[TJAlexander]

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. I'm now having to resubmit each claim with proof of electronic acceptance. In addition, I was told by a rep that BCBS in Ga is having to process claims manually and since then my corrected claims are denied as duplicate. For this problem, I'm having to log each claim on the BCBS inquiry spreadsheet. This has taken days out of my week.

Is it just me??

 

[PEC03944]

Similar problems

Did you ever find out how to resolve this? I am having trouble with electronic claims billing to BCBS of AL, which are accepted via our audit report of the batch, but then no record of the claim is found on BCBS website. I am also having trouble with new claims submitted electronically denying as duplicate when clearly this was the first time we filed the claim. It isn't just one claim, it's dozens. Calling our rep is difficult if not impossible, so I am reaching out to others who might have an answer.

Anyone else having problems?

Thanks,

K

 

[sarowe]

RE: BCBS Glitches

I am going to preface this with the fact that I am not an expert by any means. Although, I will suggest that rather than going through and resubmitting your claims with proof of electronic submission, you should try contacting their EDI department. I typically bill Carefirst BCBS of MD and am not able to speak directly to the EDI department, but there is a tech support department that opens a ticket and forwards to the EDI department for investigation and resolution (BCBS of GA may be organized differently). If you contact them, they may see where the claim was accepted into their system, but their may be a back end rejection that prevented your claims from getting through to the actual claims processing system. In which case, the EDI rep should be able to pull the claim and get it to the claims processor or at the very least tell you what went wrong and what information you will need to resubmit to avoid the error.

@PEC03944 - I would also suggest reaching out to the BCBS of AL EDI department, if you haven't already. With regard to the duplicate submission rejection, it is possible that there is a formatting issue. At one point, I was sending electronic claims to a local Medicaid plan and there was a formatting error that caused the claim to be submitted as a "corrected claim" even though it was an original submission. If you contact the EDI department, they can assist with what fields need to be completed and what format the electronic claims should be in, in order for your claims to be submitted without issues.

I hope this helps!

Samantha