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Supartz Injections

  1. #1
    North Carolina
    Exclamation Supartz Injections
    Medical Coding Books
    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?

    By the way....Happy 4th of July!
    Last edited by RebeccaWoodward*; 07-03-2008 at 02:40 PM.
    Rebecca CPC, CPMA, CEMC

    Your click COUNTS...

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  2. #2
    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

  3. #3
    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.

  4. #4
    North Carolina
    Thanks to both of you for replying. I guess I'll just have to roll up my sleeves and prepare to duke it out.
    Rebecca CPC, CPMA, CEMC

    Your click COUNTS...

    CLICK to give FREE mammograms!

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