Healthy Blue of LA issue

[PennyA_59051]

We are having an issue with Healthy Blue denying claims for only two of our providers stating a modifier is needed. There is nothing different with these two providers and Healthy Blue is denying all CPT codes and Dx billed for these two providers. Any advice or suggestions would be greatly appreciated.

 

[Lori]

Perhaps check these resources:

Healthy Blue Manual

https://provider.healthybluesc.com/docs/gpp/SCHB_CAID_ProviderManual.pdf?v=202101291853

Healthy Blue Modifiers

https://provider.healthybluesc.com/docs/inline/SCHB_RP_Coding_ModifierUsage-Surgeons.pdf?v=202103031350

Please see the denials thread here:

Resource - Denials

Review Reason Codes and Statements CMS contractors medically review some claims (and prior authorizations) to ensure that payment is billed (or authorization requested) only for services that meet all Medicare rules. If the review results in a denied/non-affirmed decision, the review contractor...

www.cco.community

 

[PennyA_59051]

Perhaps check these resources:

Healthy Blue Manual

https://provider.healthybluesc.com/docs/gpp/SCHB_CAID_ProviderManual.pdf?v=202101291853

Healthy Blue Modifiers

https://provider.healthybluesc.com/docs/inline/SCHB_RP_Coding_ModifierUsage-Surgeons.pdf?v=202103031350

Please see the denials thread here:

Resource - Denials

Review Reason Codes and Statements CMS contractors medically review some claims (and prior authorizations) to ensure that payment is billed (or authorization requested) only for services that meet all Medicare rules. If the review results in a denied/non-affirmed decision, the review contractor...

www.cco.community

Thank you. I appreciate your assistance. I have reviewed those because that was my initial thought as well. I have 20 providers. Out of those 20 providers only two providers' claims are being denied across the board by Healthy Blue and only Healthy Blue as requiring a modifier. There is nothing different about these two providers. These are for all of these two providers' claims. It's not an NCCI or CCI or MUE issue. I will review these resources again and get with our Account Rep when she returns from leave later this week if not resolved by then. Thank you for helping me brain storm. I love CCO!

 

[Lori]

Our apologies as the rep may be able to assist you better since CCO really has no clue as to what each insurance does or does not allow as I tried doing a quick search to see if I could find any useful info but none came up, unfortunately.

It did seem strange that is it just the 2 providers you are having issues with though.

Perhaps there is just some info missing regarding the 2 providers but not sure why it would be tagged for just a modifier issue.

You said they were denying everything so perhaps check to see if their NPI is correct things of that nature perhaps as I personally am clueless I admit.

Please let us know what the rep says so we know next time what the issue could be as I am curious now as well.