Wiki Claim denials / proper coding

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JenCahan

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We are a small health and wellness company that performs biometric screenings on the job sites of our clients. Our billing office is located in Florida but the patients are seen in their home state of Idaho. I am getting denials for BCBS of Idaho even though it is coded as being seen on the job site. The denial reason is it needs to be filed in Florida even though the patient is seen in Idaho. We only have a contract with the Idaho BCBS and worry that if we send it through Florida, we will be considered out of network. The insurance company has been "researching" for over 3 months. HELP!

Jennifer Cahan
 
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When you say on the "job sites" meaning the "job site" is the patients home? Also are these Telehealth? and whose billing NPI are these going under? You can PM me with a little more information if you would like. I would need more information to help in this situation.
 
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Job site means where the person works. The insurance company contracts us to health assessments for their clients who are companies that want to improve the health and well being of their employees. We have a contract with 1 health insurance company but they want us to utilize their medical benefits for payment. Our company NPI is used. It is not tied to a physician. These are in person screenings and coaching sessions. Thank you for your help. And I apologize for not PMing as I could not figure out how to do that as I am new to this site.
 
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JenCahan said:
We are a small health and wellness company that performs biometric screenings on the job sites of our clients. Our billing office is located in Florida but the patients are seen in their home state of Idaho. I am getting denials for BCBS of Idaho even though it is coded as being seen on the job site. The denial reason is it needs to be filed in Florida even though the patient is seen in Idaho. We only have a contract with the Idaho BCBS and worry that if we send it through Florida, we will be considered out of network. The insurance company has been "researching" for over 3 months. HELP!

Jennifer Cahan
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Blue Cross claims should be filed to the home plan which would be the state in which the services are furnished.
 
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JenCahan said:
That is what I have done but they are still being denied because our billing address is Florida even though the services are provided in Idaho.
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When you are billing, what is the address of the NPI for the RENDERING location/provider? There are plenty of places that use out-of-state billing providers, so that may not be the issue.
 
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