We have a patient in which we drew a blood sample for testing. The specimen is being sent to an out of state lab for testing and results. I assume that we bill the state in which the specimen was being tested in, but I have a colleague stating that we bill the state in which the sample was actually drawn in. I’m new to this part of billing, so any feedback would be appreciated! Thank you!
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Help me understand blue shield!!!!
We are out of network. We get our authorizations through Magellan but claims are processed by Blue Shield. When I check eligibility and benefits, it always says there’s a $ 2000/day max for inpatient substance abuse. But when I bill Rev Code 1002 with H0018, the allowed amount is $ 481 and they typically cover at 50% for out of network. Where does that $ 2000/day max come from if the allowed amount is going to be $ 481??. Isn’t it an all inclusive code, excluding maybe MD visits, but that wouldn’t come close to $ 2000. We get twice, three times their allowed amount with other carriers. Am I missing something? The owner is no longer wanting to take Blue Shield because he is so unhappy with the reimbursements. I am urgently trying to figure out a way to increase out reimbursement, without pushing the envelope, obviously.
Cross Posted because I am DESPERATE!!!!
Blue Shield Codes- Residential Facility-Sub Acute
The below codes have been paying very very well with Blue Shield…
S0201 (HC svc qual), 0900, 897*
H0010, (HC svc qual)0101, 867*
H0018, (HC svc qual)0100, 867
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