Wiki BCBS NC Mail back Letters

[Howard1Derm]

In NC but curious to know if this happens outside of NC as well when filing w/BCBS. In NC we have to file to our local BCBS. When filing a Corrected Claim we have to add resubmission code 7 and the original reference number on the EOB to box 22 on the CMS 1500 form to show that it is a corrected claim or BCBS NC will not process it. I have been doing this as well as documenting that it was done but we still receive what they call a mail back letter stating it is missing. I started calling and having the reps send it back for processing after confirming that the 7 and original reference number is there. Does anyone else experience this? It is very time consuming to keep fixing BCBS NC mistakes/faulty system as we are following their protocols to file a claim. Who do we contact about this issue? None of the reps seem to know how to help, their solution is to call and they will send it back but I should not have to call because I did my part.

 

[danachock]

Hi Howard1Derm
No, I do not have that experience filing a corrected claim but with any BCBS (out of state) you have to file it locally.
Is this seriously a transmission error? OR
Do you have the ability to see or ask your IT people to see if those DFT's that were actually sent AND accommodated 7 in Box 22 while DFT charges were sent.
DFT's are the charges. Do you clearly know if that number 7 was in box 22 and if it was actually sent? Please validate!!
If "7" was actually sent from your facility, it may be an integration (IT) problem on their end (BCBS) that they are just not receiving it for whatever reason.
I know I am way out of depth on coding here because I do not feel it is a coding issue, but I completely understand ORUs and DFTs in my little bubble here.
Find that IT person that can identify ORU's and DFTs and validate if number 7 was accurately place in box 22 that the other BCBS facility received.
Have a fantastic evening,
Dana

 

[Howard1Derm]

We file corrected claims to paper, so it is snail mailed to BCBS. We never send corrected claims electronically so we know for a fact that box 22 is complete. Also as mentioned in the above we have called and confirmed with the reps at BCBS that it is there, they send it back, it gets processed, and paid. One rep apologized for my inconvenience, acknowledging that their system made an error. However, my problem is we should not have to do that. Their system should recognize that it is there and process with no problem. I should not get a letter stating that it is not there when it is there. Not too long ago they used to attach everything that your office sent with the claim to the letter and it was proof that we did add the 7 and org ref#, but now they just send the letter. Sounds like a strategy or a faulty system on their end.

Thanks for the reply.