- Messages
- 8
- Location
- Hallettsville, TX
I work for a small critical access hospital/rural health clinic. We received a lot of referrals for lab work to our facility by other providers in our area and even outside our area due to the rural location of our town. I have taken the CPB course my certification is expired and I currently work in the business office doing billing. I have been here just over a year. We bill our lab claims on a UB form as an outpatient procedure.
The biggest issue I have been encountering since I started my position here is related to lab orders being denied due to "no payable diagnosis" for services rendered. Sometimes, there truly is no payable diagnosis, but most of the time there is. BCBS does not offer the "Avalon" claim review tool in my state of Texas, so we have no way of knowing how to correct these claims. Even our coding department is stumped. I was hoping there was someone here who could give me some advice or pointers that can help me prevent these write-offs. I have submitted corrected claims, I have done reconsiderations, but I am not able to appeal these denials because, they are "not appealable."
Our facility has had to write off way too much due to this issue. I would appreciate any tools or advice you can offer me.
The biggest issue I have been encountering since I started my position here is related to lab orders being denied due to "no payable diagnosis" for services rendered. Sometimes, there truly is no payable diagnosis, but most of the time there is. BCBS does not offer the "Avalon" claim review tool in my state of Texas, so we have no way of knowing how to correct these claims. Even our coding department is stumped. I was hoping there was someone here who could give me some advice or pointers that can help me prevent these write-offs. I have submitted corrected claims, I have done reconsiderations, but I am not able to appeal these denials because, they are "not appealable."
Our facility has had to write off way too much due to this issue. I would appreciate any tools or advice you can offer me.