10/14/2021

Bluecross Denial-20550 and J1030

 I am being denied on more than one patient. 20550 and J1030

The denial from the patient’s plan is valid from Blue Cross. When billing this payer, there are a lot of different plans that have specific requirements for the coverage of certain services that may not align with the policy of the local Blue Cross plan:

• Blue Card out of area plans frequently have different coverage guidelines and when a claim is forwarded from your local to the patient’s plan, they may deny services that would be appropriate by one plan but not medically necessary by another
• Certain large employer groups or unions also carve out benefits that are not in line with the local plan’s coverage criteria

To resolve these denials, the best route would be to contact Blue Cross and find out what conditions are covered under the patient’s plan- depending on the response and the documentation in the patient’s chart, the coding would either need to be corrected or an appeal would need to be submitted to justify the medical necessity of the injection.