10/01/2024

BCBSM Issues MSHO is Monitoring - We Need to Hear From You!

MSHO Members,

There are several issues we have been monitoring with BCBSM.

• BCBSM stated they have encountered a system-wide issue that is recurrent for our members, but this time is affecting all specialties. You will remember this as the exceeds auth denial code K071 and K074.  

• Additionally, we have been tracking denials on J0085 – ESA issues denying due to hemoglobin values 10 or above during the maintenance phase for patients with MDS or CIA. These are associated with denial code 693.

• Paying claims from an incorrect fee schedule (wrong month for DOS). 

We are working closely with BCBSM on these issues, but we are asking for your assistance to help get your claims paid.  

If you are experiencing any of these issues, please create an up-to-date comprehensive spreadsheet of all the claims that pertain to each of these categories and name your separate spreadsheets accordingly.  For example, you will create one spreadsheet with all the exceeds auth denials.  A second spreadsheet should be named J0881 denials. The third spreadsheet should be the underwater claims.  

Please send separate emails to billing@msho.org: one for each issue with that issue as the subject of your email.  For the underwater payments we will also need to have a copy of your invoice that proves you are underwater on the fee schedule.  

Remember, to include the claim ID information, DOS, denial codes, fee paid if any.  Each of these claims will have to be reviewed so BCBSM will need the information to find them in their system. 

As we receive your emails, they will be compiled and sent to our BCBSM team for review and hopefully processing.  

Thank you in advance for your help! We realize this is a lot of work, but we are hopeful it will pay off in the end.

Please reach out to MSHO's Reimbursement Consultant, Deb McNeilance at billing@msho.org with any questions.