Within your company you should have a payer contracting employee who can help you with this.
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Sent: Monday, July 17, 2023 10:47 AM
To: billers@list.mnhomecare.org
Subject: RE: [EXTERNAL] Re: *External Email Message*BCBS Authorization Denials
Good Morning, I have an update on the BCBS Authorization denial issue. Our provider rep has stopped responding to our inquiries. We are now up
to 53K in denials since the first of this year and fully anticipate that number doubling by the end
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Good Morning,
I have an update on the BCBS Authorization denial issue.
Our provider rep has stopped responding to our inquiries. We are now up to 53K in denials since the first of this year and fully anticipate that number doubling by the end of the year
at this rate. We have confirmed Evicore has sent the approved authorization information to BCBS and the problem solely is held within the BCBS system.
Our question is has anyone experienced a mass issue fight with BCBS? What actions did you pursue? We are considering contacting the State Insurance Commissioner, filing a complaint
with the MN Commerce Department, or filing a small claims lawsuit to get a portion of the claims paid. What has been the best route in your experience? Is there any other options that I might have missed?
I know a lot of HHC Providers are having the same issue. I am not sure to what scale, but at our scale it is not sustainable. If any other providers would like to be included in this
fight, it would certainly support all of our cases if we joined.
Thanks,
Anna
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Anna Sanderson |
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From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Sent: Tuesday, June 20, 2023 3:19 PM
To: billers@list.mnhomecare.org
Subject: RE: [EXTERNAL] Re: *External Email Message*BCBS Authorization Denials
Traci,
Where did you hear they are taking it back? Did I miss a published article somewhere? I sure hope not, I have worked with BCBS/Availity back when I billed DME and they are a mess internally.
I have only had good luck to date with Evicore. I spoke with Evicore on this and they are saying they reported it accurately to BCBS and that BCBS is the issue on this. Based on my past history with BCBS I am inclined to believe Evicore.
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Anna Sanderson |
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CONFIDENTIAL: This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received
this email in error please notify the system manager. This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this e-mail. Please notify
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of this information is strictly prohibited.
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Traci Olson
Sent: Tuesday, June 20, 2023 7:55 AM
To: billers@list.mnhomecare.org
Subject: [EXTERNAL] Re: *External Email Message*BCBS Authorization Denials
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
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**External Sender**
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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
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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