I think the episodic claim was processed incorrectly and that you should have been paid for it.  Ugh, calling BCBS is a pain because you don’t get to speak to anyone who understands Home Care billing and they are not much help.  Did you have a Q code on your claim with the first date of service?  I ask that because, I had a claim that was missing that and it took me forever to figure it out.  Nobody at provider services could tell me what was missing.

 

Marnie

 

 

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We have Medicare Secure blue clients who received therapy only, no nurse visits. We billed them as an episode of care and the claims denied. When we called, they said we have to bill therapy only as visits.  We did bill them per visit in May. Those claims are denying as wrong bill type or no auth. Auth is typically not required for Secure Blue plans. All our secure blue claims we have billed for other clients who have nurse visits have paid when billed as an episode.  I was on the phone for over an hour trying to explain they are misleading us and we do not know what to do. I got zero help. Anyone having this issue?

 

Tracy Salin

Billing Specialist

Fairview Range Home Care and Hospice