Blue Shield Claims During The Pandemic

[Karen Mullen]

I’m in Los Angeles, CA here and am seeing a trend on our Blue Shield of CA claims…….

We have 10-15 Blue Shield claims coming back each month, 30 days after Blue Shield receives the claim, to request the medical record; even though the claim has a prior auth in place.

Once I send them the medical record, they are issuing a payment of .93 cents for the first hour of chair time, only, and denying all other line items with the following reason codes:
MA46: The new information was considered but additional payment will not be issued
CO150: Payer deems the information submitted does not support this level of service
N220: Alert: See the payer’s web site or contact the payer’s Customer Service department to obtain forms and instructions for filing a provider
dispute

I’ve been placing calls to Blue Shield asking for an immediate rework for their error, citing “claims before and after have paid just fine and you have the medical record previously sent.”

I’ve been successful 75% of the time, in getting these claims sent back and paid successfully…….the other 25% of the time, I’m having to send the medical records 2-3 times because they keep saying they’re not receiving it. I’m seeing the same exact allowable of .93 cents on all 10-15 claims incorrectly paid each month.

Lastly, know that I’ve been advised about 10 different times now, buy the claims department, “we’re having trouble with our claims processing right now because of the Pandemic.”

[Melissa Silva]

We are seeing a similar issue in CT. I send records with every BCBS claim and it is still denying for no PA or medical records needed. After calling we are getting paid correctly, however it is taking 30-45 days for the denial and then another 30 days for payment.

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