I do the billing for a California RTC SA/MH facility. My biggest headache is Blue Shield of CA...for many reasons...but I'll stick to this one question for now.
We are out of network. We get our authorizations through Magellan but claims are processed by Blue Shield. When I check eligibility and benefits, it always says there's a $2000/day max for inpatient substance abuse. But when I bill Rev Code 1002 with H0018, the allowed amount is $481 and they typically cover at 50% for out of network. Where does that $2000/day max come from if the allowed amount is going to be $481??. Isn't it an all inclusive code, excluding maybe MD visits, but that wouldn't come close to $2000. We get twice, three times their allowed amount with other carriers. Am I missing something? The owner is no longer wanting to take Blue Shield because he is so unhappy with the reimbursements. I am urgently trying to figure out a way to increase out reimbursement, without pushing the envelope, obviously.
Cross Posted because I am DESPERATE!!!!
We are out of network. We get our authorizations through Magellan but claims are processed by Blue Shield. When I check eligibility and benefits, it always says there's a $2000/day max for inpatient substance abuse. But when I bill Rev Code 1002 with H0018, the allowed amount is $481 and they typically cover at 50% for out of network. Where does that $2000/day max come from if the allowed amount is going to be $481??. Isn't it an all inclusive code, excluding maybe MD visits, but that wouldn't come close to $2000. We get twice, three times their allowed amount with other carriers. Am I missing something? The owner is no longer wanting to take Blue Shield because he is so unhappy with the reimbursements. I am urgently trying to figure out a way to increase out reimbursement, without pushing the envelope, obviously.
Cross Posted because I am DESPERATE!!!!