Is anyone having issues billing modifier 25 and Blue Cross? We are having our claims denied for additional documentation, so we send in the documentation and documentation is not attached and claim is not reprocessed until I call to follow up on the claims. This is all very time consuming. We've never had to send in additional documentation when we've billed with modifier 25 before.
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Wiki Blue Cross and modifier 25
- Thread starter aktulip11@hotmail.com
- Start date
amyjph
True Blue
Are you appending modifier 25 appropriately? Sounds like your group is on pre-payment review. Has anyone looked into that? Have you gotten audits for excessive modifier 25 use?
Is it "all" claims or just certain ones? Is the group orthopedic or dermatology? Is it preventive & problem visit on the same day? What is being billed? Is a 25 being appended to all E/M inappropriately?
Also, check your provider portal and/or news bulletins and policies for the plan you are billing to.
Examples: https://providernews.anthem.com/nev...nted-evaluation-and-management-services-13023
Example OIG report re: mod 25: https://oig.hhs.gov/oei/reports/oei-07-03-00470.pdf
Example OIG work plan item: https://www.oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000577.asp
Other info: https://www.mgma.com/podcasts/ask-an-advisor-making-sense-of-modifier-25-and-modifier-57-denials
www.novitas-solutions.com
Is it "all" claims or just certain ones? Is the group orthopedic or dermatology? Is it preventive & problem visit on the same day? What is being billed? Is a 25 being appended to all E/M inappropriately?
Also, check your provider portal and/or news bulletins and policies for the plan you are billing to.
Examples: https://providernews.anthem.com/nev...nted-evaluation-and-management-services-13023
Example OIG report re: mod 25: https://oig.hhs.gov/oei/reports/oei-07-03-00470.pdf
Example OIG work plan item: https://www.oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000577.asp
Other info: https://www.mgma.com/podcasts/ask-an-advisor-making-sense-of-modifier-25-and-modifier-57-denials
Modifier 25 fact sheet
www.novitas-solutions.com