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OB Split Billing

  1. Default OB Split Billing
    Medical Coding Books
    I know the rules on splitting antepartum care billing if the patient has an insurance change, however I am fighting with the other biller in my office regarding a specific issue. If a patient switches insurance mid-pregnancy you have to split the billing, however with North Carolina Blue Cross Blue Shield policies your policy number is always the same regardless of your group number and I believe that the rules still apply to patients with this insurance. Since their policy number does not change she doesn't think we have to split the billing and can still bill global. She says that they always pay no problem so she thinks it is the correct way to bill. I, on the other hand, still stand by the fact that her insurance changed, eventhough her policy number may be the same her group number is not because she is now being covered under benefits that are different than her previous benefits and it is not the same policy. Any ideas from anyone?

  2. Default split billing maternity care
    With the Blue Shields in Washington state as long as the patient is covered under the same insurance, even if their plan within that insurance company changes, we still bill them global. We have not had a problem they usually pay at the patients benefit coverage at the time of delivery.

  3. Default
    We don't have a problem getting paid either if we bill global with our Blue Cross, however that falls under one of the major rules of coding, just because it pays doesn't mean it is being billed the correct way and you can't continue to bill it that way because you know it is getting paid regardless of whether it is right or not. I am looking for information on the LEGALLY correct way for it to be billed. Thanks.

  4. #4
    Madison Area Chapter in Madison WI
    I'd call the payer to find out for this specific case and for general information. The benefits may have changed but perhaps the policy is stil the same. Or any number of possibilities. Checking with the payer should settle it. Hope it helps.
    Happy Coding, Claudia

    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email] - website

  5. #5
    My 2 cents worth....Call the payor and ask them what they think about your scenario.

    I would call 2-3 times and speak with different representatives each time to see if you get the same answer each time. Sorry....I've just had "bad luck" with being told different things about the same issue depending on which representative I spoke with. Also, I would ask for any information I could get in writing on this so that you don't encounter problems/roadblocks after the billing is submitted.

    Good Luck!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

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