Blue Cross Blue Shield (BCBS) of Michigan is delaying their planned non-coverage of hyaluronic acid injections for knees, slated for April 1. BCBS Pulls Up BCBS giving themselves time to study if hyaluronic acid has the true medical benefit that it claims to have for patients with painful arthritic deterioration. Many patients swear by the […]
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Tag Archives: BCBS
Denial for Dexcom Diabetes Supples Insurance BCBS
I have 3 claims from 2017 being denied, insurance is BCBS of Mississippi. On line 14 of 1500 form, need completing for onset of diabetes? Could this be the reason for the denials?
BCBS 59 modifier
has anyone figured out BCBS 59 modifier denials?
BCBS Out of Network Reimbursement for SA & MH
Hi,
Has anyone else seen a dramatic drop in the oon allowable for Substance Abuse claims, even to the point that they come back over a year after paying to ask for a refund? Primary issues is with BCBS GA. Has anyone appealed and been successful?
Colonoscopy and BCBS
Does anyone have a link to BCBS and their policies on the new EGD and colonoscopy codes? Would be for Tennessee.
Thanks,
Thanks,
BCBS wellness coverage/Arkansas
I have recently learned that BCBS will no longer cover at 100% more than one wellness visit per year including the gynecology wellness. In the past, women have gotten both covered at 100%. I was told that I could use S0610/S0612-Annual GYN wellness new/established but I don’t know what dx code should be used. Does anyone have experience using this code for GYN wellness?
Thanks, Judy
BCBS denial for Subsequent observation care
Patient is BC Medicare, Cardiologist called in for a consult to observation I billed 99218 and was paid. His note states will follow up in AM of no significant arrhythmias okay to discharge from cardiac point of view. So he followed up on day 2 and patient ok for discharge, so I billed 99225 Subsequent observation care. The patients regular Doctor then discharged him. At first BC paid us but then they requested a refund for the 99225 stating can not have a 99225 and a 99217 on the same day. I appealed stating We are a different TIN, office and provider type. They upheld their decision. Is there any other way to get paid for the 99225?
Thanks
Kay
Thanks
Kay
Federal BCBS rejecting 62323 and 62321
We have been having issues all of 2017 with FEP denying 62323 and 62321. First for medical records, and then when we send them, that our providers are not eligble to perform the service.
62311 and 62310 we never had any issues with nor are we having any issues with any of our other injection codes. This is only Federal BCBS, all of the other products pay with no issues.
Has anyone else come across this?
BCBS denying E/M codes with 25 modifier
I do billing for five different practices across Texas and am having an issue with BCBS. They are denying most E/M codes when we use the 25-modifier (to distinguish from other services rendered the same day). I’ve gotten dozens of these so far. I have read some info online from different practices that BCBS is going to reduce reimbursement on E/M’s when billed with the 25-modifier to 50% of the allowed amount. But I haven’t seen anything in black and white from BCBS itself. Does anyone have any hard information on this change? The dozens of appeals are KILLING me. Maybe I shouldn’t have taken on five practices:eek:.
Z80.0 clinical edit error BCBS Michigan
Anyone experiencing denials for Z80.0 with BCBS? I’ve run into several plans that are denying Z80.0 (family hx colon cancer) as an invalid ICD10 code for high risk screening colonoscopy. I’ve talked with provider services, reported the issue and believe since Oct 1st they have an error in their clinical edits. Just curious if other states are encountering similar denials – it’s not all the plans, just a couple to date. G0105 Z80.0 denies and per the reps at BCBS, they told me their database says Z80.0 is not valid, to use another code. I’ve checked Z80.0 and it did not change or get replaced with the 2018 revisions to ICD10. Interested in any input. thx!