We have a provider who's local BCBS is Independence in PA. We have been getting denials on claims that we can't seem to correct. Each claim has been an out of state policy, not an Independence plan. The provider is an Out of network provider with a DME supplier specialty. The codes being submitted are: 99202, 70486 and E0486 with NU and KX modifiers. The 70486 and 99202 are on a different date of service than E0486. The denial that we keep receiving is as follows: claim "denied because no allowance may be made for reported services because they were performed by a contracted provider and should be sent with the appropriate code". The issue is - the provider is not contracted, not even with Dental, and the codes are the appropriate codes for the service. The E0486 was submitted with the provider's type 2 NPI in all boxes on CMS 1500, and the 99202 and 70486 were submitted with the Dentist's individual NPI as the rendering provider. The claims keep getting sent back noting that the provider is not contracted, and the reps have told me that the codes are valid medical codes. We can't understand the issue. The home plans are no help because they aren't processing the claim, so we can only talk to the host plan about it, and they just keep offering to send it back, but the results never change. Does anyone have any thoughts on what we could do differently?