Supartz Injections

RebeccaWoodward*

True Blue
Messages
3,126
Location
North Carolina
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0
Hi Everyone,

Within the last 4-5 months, BCBSNC has been scrutinizing over our documentation for the administration of our Supartz injections. Each provider has received a copy of BCBS's corporate policy. They have also had one on one training on what constitues medical necessity as well as proper documentation. Mid stream, BCBS will deny a date yet pay on others. Other patients, they deny all dates. Others, they deny the claim for lack of medical necessity without requesting one shred of evidence to support their decision. The diagnosis does warrant the service...this isn't the culprit.

After lengthy, gut wrenching appeals they are finally paid. It really appears that this has become a stall tactic with hopes that someone will adjust these off without batting an eye. BCBS is the only carrier that this applies to. All other carriers are paying for these accordingly. Has anyone else experienced this? :confused:

By the way....Happy 4th of July!
 
Last edited:

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
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I agree with you, they are stall tactics. BCBS has been denying our claims for our PA's stating that the AS modifier is invalid, yet our contract specifically states for us to use that modifier. When I call and spend 45 minutes on hold I am told "oh..that is an error on our part". GRRRRRRRRRR BCBS is not my favorite
 

LynnS.321

Networker
Messages
72
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Sorry, BC of Florida does not pay. So we give the patient an RX and have a company they can get Supartz through.
We only charge Medicare for the medicine and we order theirs.
:) Hope this helps.
 
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