annawade13
Networker
Hello-
Does anyone have any advice about the best way to handle this situation? One example would be a patient who has BCBS primary and MC secondary. BCBS is billed with a consultation code and pays, but the claim gets hung up in the clearinghouse before making it to MC because of course MC won't pay on consultations. Will MC pay as secondary? SHould I send through as a denial? Should I change the code? Do I need to reverse and rebill BCBS with a level code?
Another example is labs- we don't send labwork to the government plans as primary because they have to be billed by the outside lab, but what about if the government plan is secondary to a commercial insurance that does pay providers for labwork?
There are times when commercial payers have special codes they prefer (S-codes, for instance) and I feel comfortable changing these, but when Medicare's concerned, I always like to get a second opinion. Thanks all!
Does anyone have any advice about the best way to handle this situation? One example would be a patient who has BCBS primary and MC secondary. BCBS is billed with a consultation code and pays, but the claim gets hung up in the clearinghouse before making it to MC because of course MC won't pay on consultations. Will MC pay as secondary? SHould I send through as a denial? Should I change the code? Do I need to reverse and rebill BCBS with a level code?
Another example is labs- we don't send labwork to the government plans as primary because they have to be billed by the outside lab, but what about if the government plan is secondary to a commercial insurance that does pay providers for labwork?
There are times when commercial payers have special codes they prefer (S-codes, for instance) and I feel comfortable changing these, but when Medicare's concerned, I always like to get a second opinion. Thanks all!