Wiki DME billing BCBS

[inc1961]

We are having difficulty getting paid for durable medical equipment (DME) when our provider needs to ship the product to a patient out of our local area.

When we submit to the local Blue Card office they deny and say it needs to be submitted to the Member's Home Plan. When we do submit to the Home Plan the claim is denied stating must be submitted to the local Blue Card plan.

Is anyone having any success with this scenario?

Thank you
Sharon

 

[Michelle_Eskelsen]

out of area

We are DME here too, and we have run across several issues about out of area insurances. Humana for instance will successfully send to the correct jurisdiction if we submit wrong or patient hasn't changed address with them. Medicare will send it back to us, etc. What we find is that when we change the address at the insurance level on the patient in our software it will be sent to the correct payor(and their jurisdiction). Now,, some things we won't cover anymore if the patient left our area because the reimbursement changes and it won't be worth it. What I would do with the bcbs is use whatever the patients address is on file with Them use that,, not what the delivery address is,,,it may be two separate addresses. It should file to correct BCBS. However, without really looking at all the stuff in front of me, its easier said than done. Good Luck!
Michelle