ollielooya
True Blue
Patient has a BCBS HMO plan that processes claims first and from there it is sent on to BCBS/IL for further processing of J codes. Claims are sent electronically. On followup to BCBS/IL to check on the status of the J codes 2/3 times am told that there are no claims found. Then I go back to the primary payer who says the claims were indeed forwarded with the comment..."well, that's what the secondary payer will always say..."
At that point The HMO will ask us to fax again the claim that they have paid back to them, and that they will see to it that the claim goes to BCBS/IL again. Eventually after this second followup secondary will pay, but this is a lot of work. Do we really have to accept this as standard MO? Provider support is non-existent for the HMO. We considered dropping claims to paper as the HMO admitted there had been some ongoing problems with electronic transmissions in coordinating the two insurance companies payments benefits. Yet they still want us to send electronically.
Is this a good description of Administrative Burden, or not? What powers should we be chasing to free ourselves from this cycle of unproductivity? I'm sure the billers on this forum have some strange stories to tell in regards to seeking reimbursement.
I do love my job!
At that point The HMO will ask us to fax again the claim that they have paid back to them, and that they will see to it that the claim goes to BCBS/IL again. Eventually after this second followup secondary will pay, but this is a lot of work. Do we really have to accept this as standard MO? Provider support is non-existent for the HMO. We considered dropping claims to paper as the HMO admitted there had been some ongoing problems with electronic transmissions in coordinating the two insurance companies payments benefits. Yet they still want us to send electronically.
Is this a good description of Administrative Burden, or not? What powers should we be chasing to free ourselves from this cycle of unproductivity? I'm sure the billers on this forum have some strange stories to tell in regards to seeking reimbursement.
I do love my job!