sleeper415
Guest
Is anyone continually having issues on how their BCBS claims are being processed? I bill for a Behavioral Health group, and I bill H0035-Partial Hospitalization, the claims are inconsistently processed. Sometimes they pay 1 unit, sometimes they pay the entire billed amount, in many cases the services are denied for various inconsistent reasons. This happens within the same month of billing, no two days are ever processed the same way. I have requested a policy for this service several times and have never been provided one. I have also searched the provider resources on the payer site without much luck to verify that we are billing the services appropriately, because once again we sometimes receive denials indicating that the units are exceeded, but there has been no indication as to how the service is expected to be billed. You can no longer speak to provider services regarding claims, all the inquiries are to be sent through Availity, and it seems that once again the processing or inquiry responses are very inconsistent. My understanding is that Highmark BCBS no longer has provider reps, in the past the provider rep was always my go-to to get issues like this resolved. I have tried to find a phone number to speak with someone directly at Highmark BCBS, but all phone numbers seem to be linked to the provider services line which goes to an off-site call center. Any help or insight is greatly appreciated. Thank you.