05/01/2018

Payer Issue Tracking Page

Last Updated 5/2/18

WPS MEDICARE

No WPS Medicare reported issues at this time.

MEDICAID

Please see the Medicaid section of this newsletter for updates.

BCBSM

BCBSM is denying some drugs when the Z51.11 ICD10 code is in the first position.  

Reported 4/4/18

UDPATE 4/16/18 - BCBSM processing system requires the cancer diagnosis in the first position for claims processing even though it is outside of ICD10 Guidelines.  This includes Medicare Primary/BCBSM secondary claims.

BCBSM PPO is denying CPT 96366, therapeutic infusion additional hour when billed with 96413

Reported 4/12/18

UPDATE 4/13/18 - BCBSM has confirmed that this is a system error and has begun the process to update the system and remove this edit.

BCN

No BCN system problems reported issues at this time.

MEDICARE PLUS BLUE (MPB)

No MPB systems problems reported at this time, other than the ESA issue that is in the hands of the Medicare Ombudsman.

NOTE: If you have a payer issue that you believe is a system problem and you do not see it listed above, PLEASE report it to MSHO! 

To report, email the description of your issue, including the ICN Number, date of service, provider number and patient contract number to billing@msho.org.  Do not include the patient’s name.

REMINDER – MSHO’s role is to resolve payer issues that will/can impact all members; we do not address individual claim issues. Unique, patient specific issues should not be reported.