BCBS Claims Edits Follow Up with Responses
Bonni Wilke
Description
Collection
Title:
BCBS Claims Edits Follow Up with Responses
Creator:
Bonni Wilke
Date:
2/8/2018
Text:
Hi Listserv,
I posted an issue a few days regarding claims we are getting denied for providing more than 1 liner (L5673) a day. BCBS is denying the service with the reason that the patient has exceeded their daily limit for liners...meaning they cannot receive 2 liners on the same day.
I received multiple responses from Listserv members who have experienced similar issues but one in particular from another provider who has been having the exact same issue. Their response is below.
We have had the same exact issues and actually talked to someone at BC that had a brain and was able to help us. They referred us to the BCBS of TN provider manual VI-56 that talks about modifiers 59 and other specific modifiers for distinct procedural services. In order to get two liners paid on the same day they require you to use the LT or RT AND XU on the claims and they will pay them. Why they decided to do that on just liners I don't know but that is how you get them paid. Hope that helps!
I have since filed a corrected claim for one of our denied claims using the XU modifier as suggested and am waiting to see how that plays out. I will keep you all updated.
Thank you to everyone who took time to respond.
Bonni Wilke
Office Manager
Precision Prosthetics, Inc
1505 S Perkins Rd
Memphis, TN 38117
p. 901.682.1006
f. 901.682.5775
I posted an issue a few days regarding claims we are getting denied for providing more than 1 liner (L5673) a day. BCBS is denying the service with the reason that the patient has exceeded their daily limit for liners...meaning they cannot receive 2 liners on the same day.
I received multiple responses from Listserv members who have experienced similar issues but one in particular from another provider who has been having the exact same issue. Their response is below.
We have had the same exact issues and actually talked to someone at BC that had a brain and was able to help us. They referred us to the BCBS of TN provider manual VI-56 that talks about modifiers 59 and other specific modifiers for distinct procedural services. In order to get two liners paid on the same day they require you to use the LT or RT AND XU on the claims and they will pay them. Why they decided to do that on just liners I don't know but that is how you get them paid. Hope that helps!
I have since filed a corrected claim for one of our denied claims using the XU modifier as suggested and am waiting to see how that plays out. I will keep you all updated.
Thank you to everyone who took time to respond.
Bonni Wilke
Office Manager
Precision Prosthetics, Inc
1505 S Perkins Rd
Memphis, TN 38117
p. 901.682.1006
f. 901.682.5775
Citation
Bonni Wilke, “BCBS Claims Edits Follow Up with Responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/208687.
