I have the same issue. This is a huge reason BCBS is taking back processing claims from Evicore next year…..it’s one issue after another with them. I give up on calling customer service bc they have no clue!! Its bad! I’m still waiting for them to pay the 2023 correct rates on about 150 claims. It’s mid 2023 and this is crazy. It just doesn’t make sense. 

 

Traci Olson

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From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Marnie Pogreba <marniepogreba@lakewoodhealthsystem.com>
Sent: Monday, June 19, 2023 5:24:18 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: RE: *External Email Message*BCBS Authorization Denials

 

Yes, we are seeing this too.  We have the authorization from Evicore, we also have the authorization number on our claim and they have been denying some of the claims or just some of the visits on the claims saying the authorization is missing or invalid.   It is very frustrating and hard to get reconciled.

 

Marnie

 

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Rachael Schwindel
Sent: Monday, June 19, 2023 4:59 PM
To: 'billers@list.mnhomecare.org' <billers@list.mnhomecare.org>
Subject: RE: *External Email Message*BCBS Authorization Denials

 

**External Sender**

 

We’ve had this issue with BCBS for months! It’s not every claim but defiantly a noticeable amount. I’ve called to have claims reprocessed and appealed several of these and have been told it’s a known issue and they are “working on a fix” but I’ve heard this for at least 6 months.

 

Rachael Schwindel

Account Manager

Adara Logo_RGB_PRHC Tagline

P: 763-682-0665

F: 763-682-6543

 

 

 

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Sent: Monday, June 19, 2023 4:45 PM
To: billers@list.mnhomecare.org
Subject: *External Email Message*BCBS Authorization Denials

 

Good Afternoon,

We have been seeing a trend in Authorization denials for the BCBS Medicare plan beginning in XZL Alpha prefix. To date $45K in denials across nine patients. We have valid authorizations within the date range and service types of the denied claims and the auth number was billed on the claims. We have sent this to our BCBS Provider Relations Rep and its taking some time to review. Evicore said they have only heard of this from us but I am wondering if any other providers have been experiencing this?

 

 

 

 

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