Wiki Question on Out of State Blue Cross billing

[KolarSue]

Good morning, my practice is in RI and we bill for all BCBS plans via BCBSRI (Alabama, NY, RI etc.), as per our contract. Does anyone know if we can/need to be, credentialed with the OOS plans and can directly bill them if so? If not, and we continue to process these claims via BCBSRI, how do I know we are getting the correct reimbursement rate from our local plan? We do not have fee schedules for the OOS plans since we are not contracted/credentialed with them. We are not able to speak to a rep for those states since we are not credentialed in those OOS plans. Also, all claims inquiries have to go thru the local plan which delays any response from the OOS plan. We do have to call the OOS plan to inquire on deductibles for testing or benefits etc., but that is all we can inquire on, and those calls go off shore and are not always accurate responses. Is there a workaround to get this info so my staff doesn't have to be on hour+ calls for one patient? Thank you for your time.

 

[sls314]

Good morning, my practice is in RI and we bill for all BCBS plans via BCBSRI (Alabama, NY, RI etc.), as per our contract. Does anyone know if we can/need to be, credentialed with the OOS plans and can directly bill them if so? If not, and we continue to process these claims via BCBSRI, how do I know we are getting the correct reimbursement rate from our local plan? We do not have fee schedules for the OOS plans since we are not contracted/credentialed with them. We are not able to speak to a rep for those states since we are not credentialed in those OOS plans. Also, all claims inquiries have to go thru the local plan which delays any response from the OOS plan. We do have to call the OOS plan to inquire on deductibles for testing or benefits etc., but that is all we can inquire on, and those calls go off shore and are not always accurate responses. Is there a workaround to get this info so my staff doesn't have to be on hour+ calls for one patient? Thank you for your time.

Your reimbursement would be based on your contract with the local plan.

 

[natalir2010@gmail.com]

I agree for BCBS OOS plans, claims are billed thru your local BCBS plan and reimbursement will be based on your contract with the local. Does BCBS of RI allow you to use Availity for eligibility, benefits and claim status? I know Anthem BCBS of VA does, you might want to ask if they do as well.