Wiki Billing Question

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TBEATSON

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I have not encountered this problem in the past and am hoping that someone can assist me with the following:

Patient is seen and has two BCBS plans. The primary processes the claim and we adjust the claim to accept the allowable and file to the secondary BCBS. The secondary processes the claim at a lower allowable than the
primary. Are we to take an additional right off and bill the patient only for the amount that the secondary says she owes? We are participating with
our local BCBS. If we are to take the additional right off can someone provide me a link where I can get this in writing? Thanks for the help.
 
You should obtain the fee schedules from BCBS; they have more than one (i.e. Traditional, BPP, PPO). Depending on what type of BCBS the patient is subscribed to, it is possible for the same service to have different allowable amounts.
 
TBEATSON said:
I have not encountered this problem in the past and am hoping that someone can assist me with the following:

Patient is seen and has two BCBS plans. The primary processes the claim and we adjust the claim to accept the allowable and file to the secondary BCBS. The secondary processes the claim at a lower allowable than the
primary. Are we to take an additional right off and bill the patient only for the amount that the secondary says she owes? We are participating with
our local BCBS. If we are to take the additional right off can someone provide me a link where I can get this in writing? Thanks for the help.
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Yes, if you are a contracted provider with the secondary then you should take the allowable and bill the patient only what is instructed on the EOB. Downloading the allowables & keeping them handy in case you need to file an appeal is a good idea because allowables vary depending on the contract and the patient's benefits. I used to work for an Oncology group and several of the patient's had primary and secondaries, many times the secondaries would ask for us to take the w/o if we were contracted, however this was not always the case, because if the secondary allows more than the primary then you can appeal it and ask for additional reimb. But, If you are still left with doubt simply call the secondary.

At this time I don't have a link to refer you to, I 've gained experience fom dealing w/the carriers on a daily basis for over 15 years.

Good Luck and never let your guard down w/these carriers !!
 
I would suggest contacting your provider relations person and/or reviewing your contract. In our case, our rep was contacted and we were told the primary insurances allowance prevails. There was nothing in our contract that said we have to follow the allowance of CareFirst when they were secondary. We have this in writing in case a Carefirst representative and/or patient states otherwise. But again, that's for our particular office.

Zaida, CPC (Carefirst/Anthem specialist)
 
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