RebeccaWoodward*
True Blue
Hi Everyone,
Within the last 4-5 months, BCBSNC has been scrutinizing over our documentation for the administration of our Supartz injections. Each provider has received a copy of BCBS's corporate policy. They have also had one on one training on what constitues medical necessity as well as proper documentation. Mid stream, BCBS will deny a date yet pay on others. Other patients, they deny all dates. Others, they deny the claim for lack of medical necessity without requesting one shred of evidence to support their decision. The diagnosis does warrant the service...this isn't the culprit.
After lengthy, gut wrenching appeals they are finally paid. It really appears that this has become a stall tactic with hopes that someone will adjust these off without batting an eye. BCBS is the only carrier that this applies to. All other carriers are paying for these accordingly. Has anyone else experienced this?
By the way....Happy 4th of July!
Within the last 4-5 months, BCBSNC has been scrutinizing over our documentation for the administration of our Supartz injections. Each provider has received a copy of BCBS's corporate policy. They have also had one on one training on what constitues medical necessity as well as proper documentation. Mid stream, BCBS will deny a date yet pay on others. Other patients, they deny all dates. Others, they deny the claim for lack of medical necessity without requesting one shred of evidence to support their decision. The diagnosis does warrant the service...this isn't the culprit.
After lengthy, gut wrenching appeals they are finally paid. It really appears that this has become a stall tactic with hopes that someone will adjust these off without batting an eye. BCBS is the only carrier that this applies to. All other carriers are paying for these accordingly. Has anyone else experienced this?
By the way....Happy 4th of July!
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