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BCBS

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  • blondeblues00
    Can anyone tell me what diagnosis code to use for anxiety that Blue Cross Blue Shield will pay and not deny it due to being a mental health code. A patient
    Message 1 of 29 , Sep 29 3:58 PM
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      Can anyone tell me what diagnosis code to use for anxiety that Blue
      Cross Blue Shield will pay and not deny it due to being a mental
      health code. A patient came in because she was having panic attacks
      and thought she might be going through menopause we did blood work
      and now BCBS has denied the claim saying the patient has no mental
      health coverage, women who go through menopause have anxiety problems
      can anyone help. Thanks!
    • Helen L. Avery, CPC
      female climacteric state? My book is at work (600 range). THe gotcha here, the diagnosis in the patient s office visit note must support the menopausal
      Message 2 of 29 , Sep 29 4:45 PM
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        female climacteric state? My book is at work (600
        range). THe "gotcha" here, the diagnosis in the
        patient's office visit note must support the
        menopausal symptoms and not the anxiety... also think
        symptoms if the doctor cannot say with any certainty
        that the cause of these symptoms are related to
        anxiety.

        --- blondeblues00 <blondeblues00@...> wrote:

        > Can anyone tell me what diagnosis code to use for
        > anxiety that Blue
        > Cross Blue Shield will pay and not deny it due to
        > being a mental
        > health code. A patient came in because she was
        > having panic attacks
        > and thought she might be going through menopause we
        > did blood work
        > and now BCBS has denied the claim saying the patient
        > has no mental
        > health coverage, women who go through menopause have
        > anxiety problems
        > can anyone help. Thanks!
        >
        >




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      • nicole mezni
        When pts have BC/BS of Michigan, for example, but were treated in FL, do we submit claims to the local BC/BS (FL)? Or do we submit to MI? Or does this vary by
        Message 3 of 29 , Sep 25 8:48 PM
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          When pts have BC/BS of Michigan, for example, but were treated in FL, do we submit claims to the local BC/BS (FL)? Or do we submit to MI? Or does this vary by plan?

          Thank you!
          Nicole M. Mezni

          [Non-text portions of this message have been removed]
        • Melinda
          Nicole, Here in WA State we are required to submit all out-of-area plans to our local BCBS. The only time I submit directly to the plan is if the Medicare
          Message 4 of 29 , Sep 25 9:10 PM
          • 0 Attachment
            Nicole,

            Here in WA State we are required to submit all out-of-area plans to
            our local BCBS. The only time I submit directly to the plan is if
            the Medicare cross-over didn't work, or if I have problems;
            otherwise, I send it directly to BCBS.

            Melinda Brown, CMBS
            Ins Biller

            --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@...>
            wrote:
            >
            > When pts have BC/BS of Michigan, for example, but were treated in
            FL, do we submit claims to the local BC/BS (FL)? Or do we submit to
            MI? Or does this vary by plan?
            >
            > Thank you!
            > Nicole M. Mezni
            >
            > [Non-text portions of this message have been removed]
            >
          • Tanya Peck
            I think it s by state not by plan, but I could be wrong. I know that in Arizona, we are required to submit all BCBS plans from every state to our local plan
            Message 5 of 29 , Sep 25 9:11 PM
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              I think it's by "state" not by plan, but I could be wrong.

              I know that in Arizona, we are required to submit all BCBS plans from
              every state to our local plan AS LONG AS the patient's ID number starts
              with 3 alpha characters. If it doesn't, then we have to send to the
              home plan, whichever state that may be.

              T



              --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@...>
              wrote:
              >
              > When pts have BC/BS of Michigan, for example, but were treated in FL,
              do we submit claims to the local BC/BS (FL)? Or do we submit to MI? Or
              does this vary by plan?
              >
              > Thank you!
              > Nicole M. Mezni
              >
              > [Non-text portions of this message have been removed]
              >
            • nicole mezni
              Okay cool...thank you Melinda! :) Nicole ... From: Melinda To: MedicalBillers@yahoogroups.com Sent: Wednesday, September 26, 2007 12:10 AM Subject:
              Message 6 of 29 , Sep 25 9:13 PM
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                Okay cool...thank you Melinda! :)

                Nicole
                ----- Original Message -----
                From: Melinda
                To: MedicalBillers@yahoogroups.com
                Sent: Wednesday, September 26, 2007 12:10 AM
                Subject: [MedicalBillers] Re: BCBS


                Nicole,

                Here in WA State we are required to submit all out-of-area plans to
                our local BCBS. The only time I submit directly to the plan is if
                the Medicare cross-over didn't work, or if I have problems;
                otherwise, I send it directly to BCBS.

                Melinda Brown, CMBS
                Ins Biller

                --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@...>
                wrote:
                >
                > When pts have BC/BS of Michigan, for example, but were treated in
                FL, do we submit claims to the local BC/BS (FL)? Or do we submit to
                MI? Or does this vary by plan?
                >
                > Thank you!
                > Nicole M. Mezni
                >
                > [Non-text portions of this message have been removed]
                >





                [Non-text portions of this message have been removed]
              • debbie brosnan
                Nicole, Here is the rule. I live in Michigan. This is what I teach to my students. 1. No matter what state the patient is from as long as there is a 3 letter
                Message 7 of 29 , Sep 26 6:23 AM
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                  Nicole,

                  Here is the rule. I live in Michigan. This is what I teach to my students.

                  1. No matter what state the patient is from as long as there is a 3 letter prefix in front of the contract number the claim is sent to the bc of the state services were rendered in.

                  2. This is a national bc policy I believe there are only 2 states that do not participate with the national bc policy. As long as there is an alpha prefix bill the state bc that services were provided.

                  With this in mind the patient has BCBSMI but services were rendered in Florida. THe claim goes to BCBSFL. You will be paid the bc of florida contracted rates not the out of state plan rates. If you are not paid the bc of florida contrated rates than you have to appeal the bc of florida for additional payment. bc of florida will inturn be reimbursed behind the scenes from michigan. I hope this helps you.

                  Have a great day. Its raining here in Michigan

                  Deb

                  nicole mezni <nmezni@...> wrote:
                  Okay cool...thank you Melinda! :)

                  Nicole
                  ----- Original Message -----
                  From: Melinda
                  To: MedicalBillers@yahoogroups.com
                  Sent: Wednesday, September 26, 2007 12:10 AM
                  Subject: [MedicalBillers] Re: BCBS

                  Nicole,

                  Here in WA State we are required to submit all out-of-area plans to
                  our local BCBS. The only time I submit directly to the plan is if
                  the Medicare cross-over didn't work, or if I have problems;
                  otherwise, I send it directly to BCBS.

                  Melinda Brown, CMBS
                  Ins Biller

                  --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@...>
                  wrote:
                  >
                  > When pts have BC/BS of Michigan, for example, but were treated in
                  FL, do we submit claims to the local BC/BS (FL)? Or do we submit to
                  MI? Or does this vary by plan?
                  >
                  > Thank you!
                  > Nicole M. Mezni
                  >
                  > [Non-text portions of this message have been removed]
                  >

                  [Non-text portions of this message have been removed]






                  [Non-text portions of this message have been removed]
                • Tanya Peck
                  After reading Deb s post, it just makes me want to re-interate that it does appear to be a state by state issue as what Deb says in #1 is just not true for
                  Message 8 of 29 , Sep 26 9:08 AM
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                    After reading Deb's post, it just makes me want to re-interate that
                    it does appear to be a "state by state" issue as what Deb says in #1
                    is just not true for Arizona, and I know someone else said that they
                    also bill their local plan for all out of states (FLA, maybe??)

                    Here in AZ we have the steadfast rule that if the patient has the 3
                    alpha characters then the claims HAVE to go to our local home plan,
                    they then forward the claim to the home plan which then in turns
                    processes the claim and forwards it back to our local plan which then
                    in turn pays us.

                    Because of Deb's post and in Michigan, she has different rules, it
                    must be a state by state thing.

                    T


                    --- In MedicalBillers@yahoogroups.com, debbie brosnan
                    <thebiller_2000@...> wrote:
                    >
                    > Nicole,
                    >
                    > Here is the rule. I live in Michigan. This is what I teach to
                    my students.
                    >
                    > 1. No matter what state the patient is from as long as there is
                    a 3 letter prefix in front of the contract number the claim is sent
                    to the bc of the state services were rendered in.
                    >
                    > 2. This is a national bc policy I believe there are only 2
                    states that do not participate with the national bc policy. As long
                    as there is an alpha prefix bill the state bc that services were
                    provided.
                    >
                    > With this in mind the patient has BCBSMI but services were
                    rendered in Florida. THe claim goes to BCBSFL. You will be paid the
                    bc of florida contracted rates not the out of state plan rates. If
                    you are not paid the bc of florida contrated rates than you have to
                    appeal the bc of florida for additional payment. bc of florida will
                    inturn be reimbursed behind the scenes from michigan. I hope this
                    helps you.
                    >
                    > Have a great day. Its raining here in Michigan
                    >
                    > Deb
                    >
                    > nicole mezni <nmezni@...> wrote:
                    > Okay cool...thank you Melinda! :)
                    >
                    > Nicole
                    > ----- Original Message -----
                    > From: Melinda
                    > To: MedicalBillers@yahoogroups.com
                    > Sent: Wednesday, September 26, 2007 12:10 AM
                    > Subject: [MedicalBillers] Re: BCBS
                    >
                    > Nicole,
                    >
                    > Here in WA State we are required to submit all out-of-area plans to
                    > our local BCBS. The only time I submit directly to the plan is if
                    > the Medicare cross-over didn't work, or if I have problems;
                    > otherwise, I send it directly to BCBS.
                    >
                    > Melinda Brown, CMBS
                    > Ins Biller
                    >
                    > --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@>
                    > wrote:
                    > >
                    > > When pts have BC/BS of Michigan, for example, but were treated in
                    > FL, do we submit claims to the local BC/BS (FL)? Or do we submit to
                    > MI? Or does this vary by plan?
                    > >
                    > > Thank you!
                    > > Nicole M. Mezni
                    > >
                    > > [Non-text portions of this message have been removed]
                    > >
                    >
                    > [Non-text portions of this message have been removed]
                    >
                    >
                    >
                    >
                    >
                    >
                    > [Non-text portions of this message have been removed]
                    >
                  • Melinda
                    I m with Tanya. It used to be the way to send it direct to the home plan, and ALWAYS for billing secondary to Medicare; but times are changing, and with more
                    Message 9 of 29 , Sep 26 10:34 AM
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                      I'm with Tanya. It used to be the way to send it direct to the home
                      plan, and ALWAYS for billing secondary to Medicare; but times are
                      changing, and with more and more of the Blues linked together, most
                      all of the back of the out of state cards say "bill the local BCBS."

                      We're also doing as Tanya states: "if the patient has the 3
                      alpha characters then the claims HAVE to go to our local home plan,
                      they then forward the claim to the home plan which then in turns
                      processes the claim and forwards it back to our local plan which then
                      in turn pays us."

                      Melinda

                      --- In MedicalBillers@yahoogroups.com, "Tanya Peck" <tanya@...> wrote:
                      >
                      > After reading Deb's post, it just makes me want to re-interate that
                      > it does appear to be a "state by state" issue as what Deb says in
                      #1
                      > is just not true for Arizona, and I know someone else said that
                      they
                      > also bill their local plan for all out of states (FLA, maybe??)
                      >
                      > Here in AZ we have the steadfast rule that if the patient has the 3
                      > alpha characters then the claims HAVE to go to our local home plan,
                      > they then forward the claim to the home plan which then in turns
                      > processes the claim and forwards it back to our local plan which
                      then
                      > in turn pays us.
                      >
                      > Because of Deb's post and in Michigan, she has different rules, it
                      > must be a state by state thing.
                      >
                      > T
                      >
                      >
                      > --- In MedicalBillers@yahoogroups.com, debbie brosnan
                      > <thebiller_2000@> wrote:
                      > >
                      > > Nicole,
                      > >
                      > > Here is the rule. I live in Michigan. This is what I teach
                      to
                      > my students.
                      > >
                      > > 1. No matter what state the patient is from as long as there
                      is
                      > a 3 letter prefix in front of the contract number the claim is sent
                      > to the bc of the state services were rendered in.
                      > >
                      > > 2. This is a national bc policy I believe there are only 2
                      > states that do not participate with the national bc policy. As
                      long
                      > as there is an alpha prefix bill the state bc that services were
                      > provided.
                      > >
                      > > With this in mind the patient has BCBSMI but services were
                      > rendered in Florida. THe claim goes to BCBSFL. You will be paid
                      the
                      > bc of florida contracted rates not the out of state plan rates. If
                      > you are not paid the bc of florida contrated rates than you have to
                      > appeal the bc of florida for additional payment. bc of florida
                      will
                      > inturn be reimbursed behind the scenes from michigan. I hope this
                      > helps you.
                      > >
                      > > Have a great day. Its raining here in Michigan
                      > >
                      > > Deb
                      > >
                      > > nicole mezni <nmezni@> wrote:
                      > > Okay cool...thank you Melinda! :)
                      > >
                      > > Nicole
                      > > ----- Original Message -----
                      > > From: Melinda
                      > > To: MedicalBillers@yahoogroups.com
                      > > Sent: Wednesday, September 26, 2007 12:10 AM
                      > > Subject: [MedicalBillers] Re: BCBS
                      > >
                      > > Nicole,
                      > >
                      > > Here in WA State we are required to submit all out-of-area plans
                      to
                      > > our local BCBS. The only time I submit directly to the plan is if
                      > > the Medicare cross-over didn't work, or if I have problems;
                      > > otherwise, I send it directly to BCBS.
                      > >
                      > > Melinda Brown, CMBS
                      > > Ins Biller
                      > >
                      > > --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@>
                      > > wrote:
                      > > >
                      > > > When pts have BC/BS of Michigan, for example, but were treated
                      in
                      > > FL, do we submit claims to the local BC/BS (FL)? Or do we submit
                      to
                      > > MI? Or does this vary by plan?
                      > > >
                      > > > Thank you!
                      > > > Nicole M. Mezni
                      > > >
                      > > > [Non-text portions of this message have been removed]
                      > > >
                      > >
                      > > [Non-text portions of this message have been removed]
                      > >
                      > >
                      > >
                      > >
                      > >
                      > >
                      > > [Non-text portions of this message have been removed]
                      > >
                      >
                    • Sunne
                      Tanya, If I read correctly, you and Deb are in agreement. In my state, NC, if the patient s ID number has a 3-letter alpha prefix, we bill our (NC) local
                      Message 10 of 29 , Sep 26 5:11 PM
                      • 0 Attachment
                        Tanya,

                        If I read correctly, you and Deb are in agreement. In my state, NC, if the patient's ID number has a 3-letter alpha prefix, we bill our (NC) local bcbs. The only time we do not bill this way is when there is no 3-letter alpha prefix, and when bcbs is secondary to Medicare.

                        Tanya Peck <tanya@...> wrote:
                        After reading Deb's post, it just makes me want to re-interate that
                        it does appear to be a "state by state" issue as what Deb says in #1
                        is just not true for Arizona, and I know someone else said that they
                        also bill their local plan for all out of states (FLA, maybe??)

                        Here in AZ we have the steadfast rule that if the patient has the 3
                        alpha characters then the claims HAVE to go to our local home plan,
                        they then forward the claim to the home plan which then in turns
                        processes the claim and forwards it back to our local plan which then
                        in turn pays us.

                        Because of Deb's post and in Michigan, she has different rules, it
                        must be a state by state thing.

                        T

                        --- In MedicalBillers@yahoogroups.com, debbie brosnan
                        <thebiller_2000@...> wrote:
                        >
                        > Nicole,
                        >
                        > Here is the rule. I live in Michigan. This is what I teach to
                        my students.
                        >
                        > 1. No matter what state the patient is from as long as there is
                        a 3 letter prefix in front of the contract number the claim is sent
                        to the bc of the state services were rendered in.
                        >
                        > 2. This is a national bc policy I believe there are only 2
                        states that do not participate with the national bc policy. As long
                        as there is an alpha prefix bill the state bc that services were
                        provided.
                        >
                        > With this in mind the patient has BCBSMI but services were
                        rendered in Florida. THe claim goes to BCBSFL. You will be paid the
                        bc of florida contracted rates not the out of state plan rates. If
                        you are not paid the bc of florida contrated rates than you have to
                        appeal the bc of florida for additional payment. bc of florida will
                        inturn be reimbursed behind the scenes from michigan. I hope this
                        helps you.
                        >
                        > Have a great day. Its raining here in Michigan
                        >
                        > Deb
                        >
                        > nicole mezni <nmezni@...> wrote:
                        > Okay cool...thank you Melinda! :)
                        >
                        > Nicole
                        > ----- Original Message -----
                        > From: Melinda
                        > To: MedicalBillers@yahoogroups.com
                        > Sent: Wednesday, September 26, 2007 12:10 AM
                        > Subject: [MedicalBillers] Re: BCBS
                        >
                        > Nicole,
                        >
                        > Here in WA State we are required to submit all out-of-area plans to
                        > our local BCBS. The only time I submit directly to the plan is if
                        > the Medicare cross-over didn't work, or if I have problems;
                        > otherwise, I send it directly to BCBS.
                        >
                        > Melinda Brown, CMBS
                        > Ins Biller
                        >
                        > --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@>
                        > wrote:
                        > >
                        > > When pts have BC/BS of Michigan, for example, but were treated in
                        > FL, do we submit claims to the local BC/BS (FL)? Or do we submit to
                        > MI? Or does this vary by plan?
                        > >
                        > > Thank you!
                        > > Nicole M. Mezni
                        > >
                        > > [Non-text portions of this message have been removed]
                        > >
                        >
                        > [Non-text portions of this message have been removed]
                        >
                        >
                        >
                        >
                        >
                        >
                        > [Non-text portions of this message have been removed]
                        >






                        Live well, love much, laugh often...

                        ---------------------------------
                        Yahoo! oneSearch: Finally, mobile search that gives answers, not web links.

                        [Non-text portions of this message have been removed]
                      • Tanya Peck
                        Sunne, I went back and re-read Deb s post and the wording threw me off, it does look like we re all in agreement. : ) Hope it stops raining soon for you Deb! T
                        Message 11 of 29 , Sep 26 6:00 PM
                        • 0 Attachment
                          Sunne,

                          I went back and re-read Deb's post and the wording threw me off, it
                          does look like we're all in agreement. : )

                          Hope it stops raining soon for you Deb!

                          T

                          --- In MedicalBillers@yahoogroups.com, Sunne <sunne002@...> wrote:
                          >
                          > Tanya,
                          >
                          > If I read correctly, you and Deb are in agreement. In my state,
                          NC, if the patient's ID number has a 3-letter alpha prefix, we bill
                          our (NC) local bcbs. The only time we do not bill this way is when
                          there is no 3-letter alpha prefix, and when bcbs is secondary to
                          Medicare.
                          >
                          > Tanya Peck <tanya@...> wrote:
                          > After reading Deb's post, it just makes me want to re-
                          interate that
                          > it does appear to be a "state by state" issue as what Deb says in
                          #1
                          > is just not true for Arizona, and I know someone else said that
                          they
                          > also bill their local plan for all out of states (FLA, maybe??)
                          >
                          > Here in AZ we have the steadfast rule that if the patient has the 3
                          > alpha characters then the claims HAVE to go to our local home plan,
                          > they then forward the claim to the home plan which then in turns
                          > processes the claim and forwards it back to our local plan which
                          then
                          > in turn pays us.
                          >
                          > Because of Deb's post and in Michigan, she has different rules, it
                          > must be a state by state thing.
                          >
                          > T
                          >
                          > --- In MedicalBillers@yahoogroups.com, debbie brosnan
                          > <thebiller_2000@> wrote:
                          > >
                          > > Nicole,
                          > >
                          > > Here is the rule. I live in Michigan. This is what I teach to
                          > my students.
                          > >
                          > > 1. No matter what state the patient is from as long as there is
                          > a 3 letter prefix in front of the contract number the claim is sent
                          > to the bc of the state services were rendered in.
                          > >
                          > > 2. This is a national bc policy I believe there are only 2
                          > states that do not participate with the national bc policy. As long
                          > as there is an alpha prefix bill the state bc that services were
                          > provided.
                          > >
                          > > With this in mind the patient has BCBSMI but services were
                          > rendered in Florida. THe claim goes to BCBSFL. You will be paid the
                          > bc of florida contracted rates not the out of state plan rates. If
                          > you are not paid the bc of florida contrated rates than you have to
                          > appeal the bc of florida for additional payment. bc of florida will
                          > inturn be reimbursed behind the scenes from michigan. I hope this
                          > helps you.
                          > >
                          > > Have a great day. Its raining here in Michigan
                          > >
                          > > Deb
                          > >
                          > > nicole mezni <nmezni@> wrote:
                          > > Okay cool...thank you Melinda! :)
                          > >
                          > > Nicole
                          > > ----- Original Message -----
                          > > From: Melinda
                          > > To: MedicalBillers@yahoogroups.com
                          > > Sent: Wednesday, September 26, 2007 12:10 AM
                          > > Subject: [MedicalBillers] Re: BCBS
                          > >
                          > > Nicole,
                          > >
                          > > Here in WA State we are required to submit all out-of-area plans
                          to
                          > > our local BCBS. The only time I submit directly to the plan is if
                          > > the Medicare cross-over didn't work, or if I have problems;
                          > > otherwise, I send it directly to BCBS.
                          > >
                          > > Melinda Brown, CMBS
                          > > Ins Biller
                          > >
                          > > --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@>
                          > > wrote:
                          > > >
                          > > > When pts have BC/BS of Michigan, for example, but were treated
                          in
                          > > FL, do we submit claims to the local BC/BS (FL)? Or do we submit
                          to
                          > > MI? Or does this vary by plan?
                          > > >
                          > > > Thank you!
                          > > > Nicole M. Mezni
                          > > >
                          > > > [Non-text portions of this message have been removed]
                          > > >
                          > >
                          > > [Non-text portions of this message have been removed]
                          > >
                          > >
                          > >
                          > >
                          > >
                          > >
                          > > [Non-text portions of this message have been removed]
                          > >
                          >
                          >
                          >
                          >
                          >
                          >
                          > Live well, love much, laugh often...
                          >
                          > ---------------------------------
                          > Yahoo! oneSearch: Finally, mobile search that gives answers, not
                          web links.
                          >
                          > [Non-text portions of this message have been removed]
                          >
                        • debbie brosnan
                          Thanks Sunne, yes we are in agreement. Does anyone know the 2 states that dont participate? When I teach on this subject my students always ask me which
                          Message 12 of 29 , Sep 27 6:30 AM
                          • 0 Attachment
                            Thanks Sunne, yes we are in agreement. Does anyone know the 2 states that dont participate? When I teach on this subject my students always ask me which states dont participate with the program.

                            Yes it stopped raining. we need the rain we have had a very dry summer most crops burned up. Our trees are starting to turn colors I love the fall but hate the snow. One of these years I want to take the fall train trip up into canada. But like the rest of us it will have to wait. Maybe next year.

                            Hope everyone has a wonderful day.

                            Deb

                            Tanya Peck <tanya@...> wrote:
                            Sunne,

                            I went back and re-read Deb's post and the wording threw me off, it
                            does look like we're all in agreement. : )

                            Hope it stops raining soon for you Deb!

                            T

                            --- In MedicalBillers@yahoogroups.com, Sunne <sunne002@...> wrote:
                            >
                            > Tanya,
                            >
                            > If I read correctly, you and Deb are in agreement. In my state,
                            NC, if the patient's ID number has a 3-letter alpha prefix, we bill
                            our (NC) local bcbs. The only time we do not bill this way is when
                            there is no 3-letter alpha prefix, and when bcbs is secondary to
                            Medicare.
                            >
                            > Tanya Peck <tanya@...> wrote:
                            > After reading Deb's post, it just makes me want to re-
                            interate that
                            > it does appear to be a "state by state" issue as what Deb says in
                            #1
                            > is just not true for Arizona, and I know someone else said that
                            they
                            > also bill their local plan for all out of states (FLA, maybe??)
                            >
                            > Here in AZ we have the steadfast rule that if the patient has the 3
                            > alpha characters then the claims HAVE to go to our local home plan,
                            > they then forward the claim to the home plan which then in turns
                            > processes the claim and forwards it back to our local plan which
                            then
                            > in turn pays us.
                            >
                            > Because of Deb's post and in Michigan, she has different rules, it
                            > must be a state by state thing.
                            >
                            > T
                            >
                            > --- In MedicalBillers@yahoogroups.com, debbie brosnan
                            > <thebiller_2000@> wrote:
                            > >
                            > > Nicole,
                            > >
                            > > Here is the rule. I live in Michigan. This is what I teach to
                            > my students.
                            > >
                            > > 1. No matter what state the patient is from as long as there is
                            > a 3 letter prefix in front of the contract number the claim is sent
                            > to the bc of the state services were rendered in.
                            > >
                            > > 2. This is a national bc policy I believe there are only 2
                            > states that do not participate with the national bc policy. As long
                            > as there is an alpha prefix bill the state bc that services were
                            > provided.
                            > >
                            > > With this in mind the patient has BCBSMI but services were
                            > rendered in Florida. THe claim goes to BCBSFL. You will be paid the
                            > bc of florida contracted rates not the out of state plan rates. If
                            > you are not paid the bc of florida contrated rates than you have to
                            > appeal the bc of florida for additional payment. bc of florida will
                            > inturn be reimbursed behind the scenes from michigan. I hope this
                            > helps you.
                            > >
                            > > Have a great day. Its raining here in Michigan
                            > >
                            > > Deb
                            > >
                            > > nicole mezni <nmezni@> wrote:
                            > > Okay cool...thank you Melinda! :)
                            > >
                            > > Nicole
                            > > ----- Original Message -----
                            > > From: Melinda
                            > > To: MedicalBillers@yahoogroups.com
                            > > Sent: Wednesday, September 26, 2007 12:10 AM
                            > > Subject: [MedicalBillers] Re: BCBS
                            > >
                            > > Nicole,
                            > >
                            > > Here in WA State we are required to submit all out-of-area plans
                            to
                            > > our local BCBS. The only time I submit directly to the plan is if
                            > > the Medicare cross-over didn't work, or if I have problems;
                            > > otherwise, I send it directly to BCBS.
                            > >
                            > > Melinda Brown, CMBS
                            > > Ins Biller
                            > >
                            > > --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@>
                            > > wrote:
                            > > >
                            > > > When pts have BC/BS of Michigan, for example, but were treated
                            in
                            > > FL, do we submit claims to the local BC/BS (FL)? Or do we submit
                            to
                            > > MI? Or does this vary by plan?
                            > > >
                            > > > Thank you!
                            > > > Nicole M. Mezni
                            > > >
                            > > > [Non-text portions of this message have been removed]
                            > > >
                            > >
                            > > [Non-text portions of this message have been removed]
                            > >
                            > >
                            > >
                            > >
                            > >
                            > >
                            > > [Non-text portions of this message have been removed]
                            > >
                            >
                            >
                            >
                            >
                            >
                            >
                            > Live well, love much, laugh often...
                            >
                            > ---------------------------------
                            > Yahoo! oneSearch: Finally, mobile search that gives answers, not
                            web links.
                            >
                            > [Non-text portions of this message have been removed]
                            >






                            [Non-text portions of this message have been removed]
                          • Joktan Edison
                            We do billing for cardiology providers, is there any specific CPT codes for ICU or else we could use the same as critical care codes 99291, 2 & 3. I would
                            Message 13 of 29 , Sep 27 9:03 AM
                            • 0 Attachment
                              We do billing for cardiology providers, is there any
                              specific CPT codes for ICU or else we could use the
                              same as critical care codes 99291, 2 & 3.

                              I would appreciate your suggestion and feedback since
                              the provider is telling us to use ICU codes.






                              ____________________________________________________________________________________
                              Luggage? GPS? Comic books?
                              Check out fitting gifts for grads at Yahoo! Search
                              http://search.yahoo.com/search?fr=oni_on_mail&p=graduation+gifts&cs=bz
                            • B Burgess
                              Yes, the critical care codes would be appropriate for the ICU setting provided, of course, that s what the provider was doing and the time and care is
                              Message 14 of 29 , Sep 27 10:58 AM
                              • 0 Attachment
                                Yes, the critical care codes would be appropriate for the ICU setting provided, of course, that's what the provider was doing and the time and care is correctly documented. Keep in mind that routine visits to ICU, CCU, SICU, etc to see a stable patient are probably not critical care, but regular hospital subseqent visits.



                                Joktan Edison <ejoktan@...> wrote:
                                We do billing for cardiology providers, is there any
                                specific CPT codes for ICU or else we could use the
                                same as critical care codes 99291, 2 & 3.

                                I would appreciate your suggestion and feedback since
                                the provider is telling us to use ICU codes.

                                __________________________________________________________
                                Luggage? GPS? Comic books?
                                Check out fitting gifts for grads at Yahoo! Search
                                http://search.yahoo.com/search?fr=oni_on_mail&p=graduation+gifts&cs=bz





                                Barbara Burgess, RN, CPC, ACS-EM
                                University of South Alabama
                                Department of Compliance and Reimbursement


                                ---------------------------------
                                Catch up on fall's hot new shows on Yahoo! TV. Watch previews, get listings, and more!

                                [Non-text portions of this message have been removed]
                              • Joktan Edison
                                Thanks for your quick update, however do you have any codes in mind which you could suggest. Your valuable feedback will be really appreciatable. ...
                                Message 15 of 29 , Sep 27 11:18 AM
                                • 0 Attachment
                                  Thanks for your quick update, however do you have any
                                  codes in mind which you could suggest. Your valuable
                                  feedback will be really appreciatable.


                                  --- B Burgess <granbfly@...> wrote:

                                  > Yes, the critical care codes would be appropriate
                                  > for the ICU setting provided, of course, that's what
                                  > the provider was doing and the time and care is
                                  > correctly documented. Keep in mind that routine
                                  > visits to ICU, CCU, SICU, etc to see a stable
                                  > patient are probably not critical care, but regular
                                  > hospital subseqent visits.
                                  >
                                  >
                                  >
                                  > Joktan Edison <ejoktan@...> wrote:
                                  > We do billing for cardiology providers, is
                                  > there any
                                  > specific CPT codes for ICU or else we could use the
                                  > same as critical care codes 99291, 2 & 3.
                                  >
                                  > I would appreciate your suggestion and feedback
                                  > since
                                  > the provider is telling us to use ICU codes.
                                  >
                                  >
                                  __________________________________________________________
                                  > Luggage? GPS? Comic books?
                                  > Check out fitting gifts for grads at Yahoo! Search
                                  >
                                  http://search.yahoo.com/search?fr=oni_on_mail&p=graduation+gifts&cs=bz
                                  >
                                  >
                                  >
                                  >
                                  >
                                  > Barbara Burgess, RN, CPC, ACS-EM
                                  > University of South Alabama
                                  > Department of Compliance and Reimbursement
                                  >
                                  >
                                  > ---------------------------------
                                  > Catch up on fall's hot new shows on Yahoo! TV.
                                  > Watch previews, get listings, and more!
                                  >
                                  > [Non-text portions of this message have been
                                  > removed]
                                  >
                                  >







                                  ____________________________________________________________________________________
                                  Boardwalk for $500? In 2007? Ha! Play Monopoly Here and Now (it's updated for today's economy) at Yahoo! Games.
                                  http://get.games.yahoo.com/proddesc?gamekey=monopolyherenow
                                • B Burgess
                                  the same ones you asked about.......(by the way, there are only two levels for CC, not three) critical care..............(assuming this is an adult patient)
                                  Message 16 of 29 , Sep 27 11:52 AM
                                  • 0 Attachment
                                    the same ones you asked about.......(by the way, there are only two levels for CC, not three)

                                    critical care..............(assuming this is an adult patient)
                                    99291 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes
                                    99292 Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service)
                                    or the regular hospital codes.............99231, 99232, 99233
                                    and/or prolonged care codes if applicable.

                                    Barbara

                                    Joktan Edison <ejoktan@...> wrote:
                                    Thanks for your quick update, however do you have any
                                    codes in mind which you could suggest. Your valuable
                                    feedback will be really appreciatable.

                                    --- B Burgess <granbfly@...> wrote:

                                    > Yes, the critical care codes would be appropriate
                                    > for the ICU setting provided, of course, that's what
                                    > the provider was doing and the time and care is
                                    > correctly documented. Keep in mind that routine
                                    > visits to ICU, CCU, SICU, etc to see a stable
                                    > patient are probably not critical care, but regular
                                    > hospital subseqent visits.
                                    >
                                    >
                                    >
                                    > Joktan Edison <ejoktan@...> wrote:
                                    > We do billing for cardiology providers, is
                                    > there any
                                    > specific CPT codes for ICU or else we could use the
                                    > same as critical care codes 99291, 2 & 3.
                                    >
                                    > I would appreciate your suggestion and feedback
                                    > since
                                    > the provider is telling us to use ICU codes.
                                    >
                                    >
                                    __________________________________________________________
                                    > Luggage? GPS? Comic books?
                                    > Check out fitting gifts for grads at Yahoo! Search
                                    >
                                    http://search.yahoo.com/search?fr=oni_on_mail&p=graduation+gifts&cs=bz
                                    >
                                    >
                                    >
                                    >
                                    >
                                    > Barbara Burgess, RN, CPC, ACS-EM
                                    > University of South Alabama
                                    > Department of Compliance and Reimbursement
                                    >
                                    >
                                    > ---------------------------------
                                    > Catch up on fall's hot new shows on Yahoo! TV.
                                    > Watch previews, get listings, and more!
                                    >
                                    > [Non-text portions of this message have been
                                    > removed]
                                    >
                                    >

                                    __________________________________________________________
                                    Boardwalk for $500? In 2007? Ha! Play Monopoly Here and Now (it's updated for today's economy) at Yahoo! Games.
                                    http://get.games.yahoo.com/proddesc?gamekey=monopolyherenow





                                    ---------------------------------
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                                    [Non-text portions of this message have been removed]
                                  • Joktan Edison
                                    Thanks Barbara, I really appreciate your help and time. However, my doctor feels what we are using the wrong codes. I dont know how to explain him. Joktan ...
                                    Message 17 of 29 , Sep 27 12:49 PM
                                    • 0 Attachment
                                      Thanks Barbara, I really appreciate your help and
                                      time. However, my doctor feels what we are using the
                                      wrong codes. I dont know how to explain him.

                                      Joktan

                                      --- B Burgess <granbfly@...> wrote:

                                      > the same ones you asked about.......(by the way,
                                      > there are only two levels for CC, not three)
                                      >
                                      > critical care..............(assuming this is an
                                      > adult patient)
                                      > 99291 Critical care, evaluation and
                                      > management of the critically ill or critically
                                      > injured patient; first 30-74 minutes
                                      > 99292 Critical care, evaluation and
                                      > management of the critically ill or critically
                                      > injured patient; each additional 30 minutes (List
                                      > separately in addition to code for primary service)
                                      > or the regular hospital codes.............99231,
                                      > 99232, 99233
                                      > and/or prolonged care codes if applicable.
                                      >
                                      > Barbara
                                      >
                                      > Joktan Edison <ejoktan@...> wrote:
                                      > Thanks for your quick update, however do
                                      > you have any
                                      > codes in mind which you could suggest. Your valuable
                                      > feedback will be really appreciatable.
                                      >
                                      > --- B Burgess <granbfly@...> wrote:
                                      >
                                      > > Yes, the critical care codes would be appropriate
                                      > > for the ICU setting provided, of course, that's
                                      > what
                                      > > the provider was doing and the time and care is
                                      > > correctly documented. Keep in mind that routine
                                      > > visits to ICU, CCU, SICU, etc to see a stable
                                      > > patient are probably not critical care, but
                                      > regular
                                      > > hospital subseqent visits.
                                      > >
                                      > >
                                      > >
                                      > > Joktan Edison <ejoktan@...> wrote:
                                      > > We do billing for cardiology providers, is
                                      > > there any
                                      > > specific CPT codes for ICU or else we could use
                                      > the
                                      > > same as critical care codes 99291, 2 & 3.
                                      > >
                                      > > I would appreciate your suggestion and feedback
                                      > > since
                                      > > the provider is telling us to use ICU codes.
                                      > >
                                      > >
                                      >
                                      __________________________________________________________
                                      > > Luggage? GPS? Comic books?
                                      > > Check out fitting gifts for grads at Yahoo! Search
                                      > >
                                      >
                                      http://search.yahoo.com/search?fr=oni_on_mail&p=graduation+gifts&cs=bz
                                      > >
                                      > >
                                      > >
                                      > >
                                      > >
                                      > > Barbara Burgess, RN, CPC, ACS-EM
                                      > > University of South Alabama
                                      > > Department of Compliance and Reimbursement
                                      > >
                                      > >
                                      > > ---------------------------------
                                      > > Catch up on fall's hot new shows on Yahoo! TV.
                                      > > Watch previews, get listings, and more!
                                      > >
                                      > > [Non-text portions of this message have been
                                      > > removed]
                                      > >
                                      > >
                                      >
                                      >
                                      __________________________________________________________
                                      > Boardwalk for $500? In 2007? Ha! Play Monopoly Here
                                      > and Now (it's updated for today's economy) at Yahoo!
                                      > Games.
                                      >
                                      http://get.games.yahoo.com/proddesc?gamekey=monopolyherenow
                                      >
                                      >
                                      >
                                      >
                                      >
                                      >
                                      > ---------------------------------
                                      > Looking for a deal? Find great prices on flights and
                                      > hotels with Yahoo! FareChase.
                                      >
                                      > [Non-text portions of this message have been
                                      > removed]
                                      >
                                      >







                                      ____________________________________________________________________________________
                                      Building a website is a piece of cake. Yahoo! Small Business gives you all the tools to get online.
                                      http://smallbusiness.yahoo.com/webhosting
                                    • B Burgess
                                      What codes are you using, and what codes does he want you to use ?? Joktan Edison wrote: Thanks Barbara, I really appreciate your help and
                                      Message 18 of 29 , Sep 27 2:03 PM
                                      • 0 Attachment
                                        What codes are you using, and what codes does he want you to use ??



                                        Joktan Edison <ejoktan@...> wrote:
                                        Thanks Barbara, I really appreciate your help and
                                        time. However, my doctor feels what we are using the
                                        wrong codes. I dont know how to explain him.

                                        Joktan

                                        --- B Burgess <granbfly@...> wrote:

                                        > the same ones you asked about.......(by the way,
                                        > there are only two levels for CC, not three)
                                        >
                                        > critical care..............(assuming this is an
                                        > adult patient)
                                        > 99291 Critical care, evaluation and
                                        > management of the critically ill or critically
                                        > injured patient; first 30-74 minutes
                                        > 99292 Critical care, evaluation and
                                        > management of the critically ill or critically
                                        > injured patient; each additional 30 minutes (List
                                        > separately in addition to code for primary service)
                                        > or the regular hospital codes.............99231,
                                        > 99232, 99233
                                        > and/or prolonged care codes if applicable.
                                        >
                                        > Barbara
                                        >
                                        > Joktan Edison <ejoktan@...> wrote:
                                        > Thanks for your quick update, however do
                                        > you have any
                                        > codes in mind which you could suggest. Your valuable
                                        > feedback will be really appreciatable.
                                        >
                                        > --- B Burgess <granbfly@...> wrote:
                                        >
                                        > > Yes, the critical care codes would be appropriate
                                        > > for the ICU setting provided, of course, that's
                                        > what
                                        > > the provider was doing and the time and care is
                                        > > correctly documented. Keep in mind that routine
                                        > > visits to ICU, CCU, SICU, etc to see a stable
                                        > > patient are probably not critical care, but
                                        > regular
                                        > > hospital subseqent visits.
                                        > >
                                        > >
                                        > >
                                        > > Joktan Edison <ejoktan@...> wrote:
                                        > > We do billing for cardiology providers, is
                                        > > there any
                                        > > specific CPT codes for ICU or else we could use
                                        > the
                                        > > same as critical care codes 99291, 2 & 3.
                                        > >
                                        > > I would appreciate your suggestion and feedback
                                        > > since
                                        > > the provider is telling us to use ICU codes.
                                        > >
                                        > >
                                        >
                                        __________________________________________________________
                                        > > Luggage? GPS? Comic books?
                                        > > Check out fitting gifts for grads at Yahoo! Search
                                        > >
                                        >
                                        http://search.yahoo.com/search?fr=oni_on_mail&p=graduation+gifts&cs=bz
                                        > >
                                        > >
                                        > >
                                        > >
                                        > >
                                        > > Barbara Burgess, RN, CPC, ACS-EM
                                        > > University of South Alabama
                                        > > Department of Compliance and Reimbursement
                                        > >
                                        > >
                                        > > ---------------------------------
                                        > > Catch up on fall's hot new shows on Yahoo! TV.
                                        > > Watch previews, get listings, and more!
                                        > >
                                        > > [Non-text portions of this message have been
                                        > > removed]
                                        > >
                                        > >
                                        >
                                        >
                                        __________________________________________________________
                                        > Boardwalk for $500? In 2007? Ha! Play Monopoly Here
                                        > and Now (it's updated for today's economy) at Yahoo!
                                        > Games.
                                        >
                                        http://get.games.yahoo.com/proddesc?gamekey=monopolyherenow
                                        >
                                        >
                                        >
                                        >
                                        >
                                        >
                                        > ---------------------------------
                                        > Looking for a deal? Find great prices on flights and
                                        > hotels with Yahoo! FareChase.
                                        >
                                        > [Non-text portions of this message have been
                                        > removed]
                                        >
                                        >

                                        __________________________________________________________
                                        Building a website is a piece of cake. Yahoo! Small Business gives you all the tools to get online.
                                        http://smallbusiness.yahoo.com/webhosting





                                        ---------------------------------
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                                        [Non-text portions of this message have been removed]
                                      • Joktan Edison
                                        We are using the same what I have mentioned earlier since I was working for same speciality couple of years before. My doctor saying that we are using wrong
                                        Message 19 of 29 , Sep 27 2:10 PM
                                        • 0 Attachment
                                          We are using the same what I have mentioned earlier
                                          since I was working for same speciality couple of
                                          years before. My doctor saying that we are using wrong
                                          codes however he is not giving me the correct one as
                                          per his knowledge. Anyway, I'm meeting him tomorrow
                                          and will go from there.

                                          Thanks for your time Barbara.

                                          Joktan


                                          --- B Burgess <granbfly@...> wrote:

                                          > What codes are you using, and what codes does he
                                          > want you to use ??
                                          >
                                          >
                                          >
                                          > Joktan Edison <ejoktan@...> wrote:
                                          > Thanks Barbara, I really appreciate your
                                          > help and
                                          > time. However, my doctor feels what we are using the
                                          > wrong codes. I dont know how to explain him.
                                          >
                                          > Joktan
                                          >
                                          > --- B Burgess <granbfly@...> wrote:
                                          >
                                          > > the same ones you asked about.......(by the way,
                                          > > there are only two levels for CC, not three)
                                          > >
                                          > > critical care..............(assuming this is an
                                          > > adult patient)
                                          > > 99291 Critical care, evaluation and
                                          > > management of the critically ill or critically
                                          > > injured patient; first 30-74 minutes
                                          > > 99292 Critical care, evaluation and
                                          > > management of the critically ill or critically
                                          > > injured patient; each additional 30 minutes (List
                                          > > separately in addition to code for primary
                                          > service)
                                          > > or the regular hospital codes.............99231,
                                          > > 99232, 99233
                                          > > and/or prolonged care codes if applicable.
                                          > >
                                          > > Barbara
                                          > >
                                          > > Joktan Edison <ejoktan@...> wrote:
                                          > > Thanks for your quick update, however do
                                          > > you have any
                                          > > codes in mind which you could suggest. Your
                                          > valuable
                                          > > feedback will be really appreciatable.
                                          > >
                                          > > --- B Burgess <granbfly@...> wrote:
                                          > >
                                          > > > Yes, the critical care codes would be
                                          > appropriate
                                          > > > for the ICU setting provided, of course, that's
                                          > > what
                                          > > > the provider was doing and the time and care is
                                          > > > correctly documented. Keep in mind that routine
                                          > > > visits to ICU, CCU, SICU, etc to see a stable
                                          > > > patient are probably not critical care, but
                                          > > regular
                                          > > > hospital subseqent visits.
                                          > > >
                                          > > >
                                          > > >
                                          > > > Joktan Edison <ejoktan@...> wrote:
                                          > > > We do billing for cardiology providers, is
                                          > > > there any
                                          > > > specific CPT codes for ICU or else we could use
                                          > > the
                                          > > > same as critical care codes 99291, 2 & 3.
                                          > > >
                                          > > > I would appreciate your suggestion and feedback
                                          > > > since
                                          > > > the provider is telling us to use ICU codes.
                                          > > >
                                          > > >
                                          > >
                                          >
                                          __________________________________________________________
                                          > > > Luggage? GPS? Comic books?
                                          > > > Check out fitting gifts for grads at Yahoo!
                                          > Search
                                          > > >
                                          > >
                                          >
                                          http://search.yahoo.com/search?fr=oni_on_mail&p=graduation+gifts&cs=bz
                                          > > >
                                          > > >
                                          > > >
                                          > > >
                                          > > >
                                          > > > Barbara Burgess, RN, CPC, ACS-EM
                                          > > > University of South Alabama
                                          > > > Department of Compliance and Reimbursement
                                          > > >
                                          > > >
                                          > > > ---------------------------------
                                          > > > Catch up on fall's hot new shows on Yahoo! TV.
                                          > > > Watch previews, get listings, and more!
                                          > > >
                                          > > > [Non-text portions of this message have been
                                          > > > removed]
                                          > > >
                                          > > >
                                          > >
                                          > >
                                          >
                                          __________________________________________________________
                                          > > Boardwalk for $500? In 2007? Ha! Play Monopoly
                                          > Here
                                          > > and Now (it's updated for today's economy) at
                                          > Yahoo!
                                          > > Games.
                                          > >
                                          >
                                          http://get.games.yahoo.com/proddesc?gamekey=monopolyherenow
                                          > >
                                          > >
                                          > >
                                          > >
                                          > >
                                          > >
                                          > > ---------------------------------
                                          > > Looking for a deal? Find great prices on flights
                                          > and
                                          > > hotels with Yahoo! FareChase.
                                          > >
                                          > > [Non-text portions of this message have been
                                          > > removed]
                                          > >
                                          > >
                                          >
                                          >
                                          __________________________________________________________
                                          > Building a website is a piece of cake. Yahoo! Small
                                          > Business gives you all the tools to get online.
                                          > http://smallbusiness.yahoo.com/webhosting
                                          >
                                          >
                                          >
                                          >
                                          >
                                          > ---------------------------------
                                          > Don't let your dream ride pass you by. Make it a
                                          > reality with Yahoo! Autos.
                                          >
                                          > [Non-text portions of this message have been
                                          > removed]
                                          >
                                          >







                                          ____________________________________________________________________________________
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                                          to amazing places on Yahoo! Travel.
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                                        • Hans Then
                                          Hi, Can a IDTF (Idependent diagnostic testing facility) bill for Mammograms? I have a bunch of claims that kicked back from Medicare stating that the
                                          Message 20 of 29 , Sep 28 2:45 PM
                                          • 0 Attachment
                                            Hi, Can a IDTF (Idependent diagnostic testing facility) bill for Mammograms? I have a bunch of claims that kicked back from Medicare stating that the

                                            HCPC/MODIFIERS: 77057/TC/ / /
                                            422143C P-O-T: 11 LINE ERROR #:422
                                            <-MSG-> INVALID ID FOR MAMMOGRAM PROCEDURE

                                            Alot of money out there, would really appreciate your help...





                                            ---------------------------------
                                            Luggage? GPS? Comic books?
                                            Check out fitting gifts for grads at Yahoo! Search.

                                            [Non-text portions of this message have been removed]
                                          • bexx1232000
                                            Deb, I also live in Michigan, I m outside of Flint and I also teach medical billing. Where are you teaching? Becki Woodhams In MedicalBillers@yahoogroups.com,
                                            Message 21 of 29 , Sep 28 5:12 PM
                                            • 0 Attachment
                                              Deb,

                                              I also live in Michigan, I'm outside of Flint and I also teach medical
                                              billing. Where are you teaching?

                                              Becki Woodhams



                                              In MedicalBillers@yahoogroups.com, debbie brosnan <thebiller_2000@...>
                                              wrote:
                                              >
                                              > Nicole,
                                              >
                                              > Here is the rule. I live in Michigan. This is what I teach to
                                              my students.
                                              >
                                              > 1. No matter what state the patient is from as long as there is a
                                              3 letter prefix in front of the contract number the claim is sent to
                                              the bc of the state services were rendered in.
                                              >
                                              >
                                            • B Burgess
                                              From the medicare claims processing manual Chapter 13 Radiology services............... http://www.cms.hhs.gov/manuals/downloads/clm104c13.pdf 20.2.2 -
                                              Message 22 of 29 , Sep 29 2:30 PM
                                              • 0 Attachment
                                                From the medicare claims processing manual Chapter 13 Radiology services...............

                                                http://www.cms.hhs.gov/manuals/downloads/clm104c13.pdf

                                                20.2.2 - Services Not Furnished in Hospitals
                                                (Rev. 1, 10-01-03)
                                                Carriers must pay under the fee schedule for the TC of radiology services furnished to
                                                beneficiaries who are not patients of any hospital, and who receive services in a
                                                physicianÂ’s office, a freestanding imaging or radiation oncology center, or other setting
                                                that is not part of a hospital.


                                                Hans Then <jhansthene@...> wrote: Hi, Can a IDTF (Idependent diagnostic testing facility) bill for Mammograms? I have a bunch of claims that kicked back from Medicare stating that the

                                                HCPC/MODIFIERS: 77057/TC/ / /
                                                422143C P-O-T: 11 LINE ERROR #:422
                                                <-MSG-> INVALID ID FOR MAMMOGRAM PROCEDURE

                                                Alot of money out there, would really appreciate your help...

                                                ---------------------------------
                                                Luggage? GPS? Comic books?
                                                Check out fitting gifts for grads at Yahoo! Search.

                                                [Non-text portions of this message have been removed]






                                                ---------------------------------
                                                Looking for a deal? Find great prices on flights and hotels with Yahoo! FareChase.

                                                [Non-text portions of this message have been removed]
                                              • B Burgess
                                                Also,,,,,,,,,,, see if this link is any help http://www.cms.hhs.gov/Mammography/06_coding_bill.asp#TopOfPage Barbara Burgess, RN, CPC, ACS-EM Hans Then
                                                Message 23 of 29 , Sep 29 2:32 PM
                                                • 0 Attachment
                                                  Also,,,,,,,,,,, see if this link is any help

                                                  http://www.cms.hhs.gov/Mammography/06_coding_bill.asp#TopOfPage

                                                  Barbara Burgess, RN, CPC, ACS-EM

                                                  Hans Then <jhansthene@...> wrote:
                                                  Hi, Can a IDTF (Idependent diagnostic testing facility) bill for Mammograms? I have a bunch of claims that kicked back from Medicare stating that the

                                                  HCPC/MODIFIERS: 77057/TC/ / /
                                                  422143C P-O-T: 11 LINE ERROR #:422
                                                  <-MSG-> INVALID ID FOR MAMMOGRAM PROCEDURE

                                                  Alot of money out there, would really appreciate your help...

                                                  ---------------------------------
                                                  Luggage? GPS? Comic books?
                                                  Check out fitting gifts for grads at Yahoo! Search.

                                                  [Non-text portions of this message have been removed]






                                                  ---------------------------------
                                                  Pinpoint customers who are looking for what you sell.

                                                  [Non-text portions of this message have been removed]
                                                • debbie brosnan
                                                  Hi Becki, Glad to know there is a michigander in here. I live in Jackson and teach at Jackson Community college. I also work for a surgery center in West
                                                  Message 24 of 29 , Oct 1, 2007
                                                  • 0 Attachment
                                                    Hi Becki,

                                                    Glad to know there is a michigander in here. I live in Jackson and teach at Jackson Community college. I also work for a surgery center in West Bloomfield. I have a collegue that is looking for reception work in the Flint area do you know of any?

                                                    Where do you teach?

                                                    Deb

                                                    bexx1232000 <billing@...> wrote:
                                                    Deb,

                                                    I also live in Michigan, I'm outside of Flint and I also teach medical
                                                    billing. Where are you teaching?

                                                    Becki Woodhams

                                                    In MedicalBillers@yahoogroups.com, debbie brosnan <thebiller_2000@...>
                                                    wrote:
                                                    >
                                                    > Nicole,
                                                    >
                                                    > Here is the rule. I live in Michigan. This is what I teach to
                                                    my students.
                                                    >
                                                    > 1. No matter what state the patient is from as long as there is a
                                                    3 letter prefix in front of the contract number the claim is sent to
                                                    the bc of the state services were rendered in.
                                                    >
                                                    >






                                                    [Non-text portions of this message have been removed]
                                                  • nicole mezni
                                                    Thanks everyone for your responses. I did notice on most of the out of state BC/BS cards, they do say to submit to your local BC/BS office. I will call just to
                                                    Message 25 of 29 , Oct 1, 2007
                                                    • 0 Attachment
                                                      Thanks everyone for your responses.

                                                      I did notice on most of the out of state BC/BS cards, they do say to submit to your local BC/BS office. I will call just to make sure, but I think I'll be doing the same as you all do.
                                                      I really appreciate your help and input!

                                                      I do have one more question though, if the BC/BS plan is SECONDARY but it is out of state, do I still submit to the local? If not, what provider number would I use? The provider's local BC/BS ID?
                                                      Thanks again,
                                                      Nicole


                                                      ----- Original Message -----
                                                      From: debbie brosnan
                                                      To: MedicalBillers@yahoogroups.com
                                                      Sent: Wednesday, September 26, 2007 9:23 AM
                                                      Subject: Re: [MedicalBillers] Re: BCBS


                                                      Nicole,

                                                      Here is the rule. I live in Michigan. This is what I teach to my students.

                                                      1. No matter what state the patient is from as long as there is a 3 letter prefix in front of the contract number the claim is sent to the bc of the state services were rendered in.

                                                      2. This is a national bc policy I believe there are only 2 states that do not participate with the national bc policy. As long as there is an alpha prefix bill the state bc that services were provided.

                                                      With this in mind the patient has BCBSMI but services were rendered in Florida. THe claim goes to BCBSFL. You will be paid the bc of florida contracted rates not the out of state plan rates. If you are not paid the bc of florida contrated rates than you have to appeal the bc of florida for additional payment. bc of florida will inturn be reimbursed behind the scenes from michigan. I hope this helps you.

                                                      Have a great day. Its raining here in Michigan

                                                      Deb

                                                      nicole mezni <nmezni@...> wrote:
                                                      Okay cool...thank you Melinda! :)

                                                      Nicole
                                                      ----- Original Message -----
                                                      From: Melinda
                                                      To: MedicalBillers@yahoogroups.com
                                                      Sent: Wednesday, September 26, 2007 12:10 AM
                                                      Subject: [MedicalBillers] Re: BCBS

                                                      Nicole,

                                                      Here in WA State we are required to submit all out-of-area plans to
                                                      our local BCBS. The only time I submit directly to the plan is if
                                                      the Medicare cross-over didn't work, or if I have problems;
                                                      otherwise, I send it directly to BCBS.

                                                      Melinda Brown, CMBS
                                                      Ins Biller

                                                      --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@...>
                                                      wrote:
                                                      >
                                                      > When pts have BC/BS of Michigan, for example, but were treated in
                                                      FL, do we submit claims to the local BC/BS (FL)? Or do we submit to
                                                      MI? Or does this vary by plan?
                                                      >
                                                      > Thank you!
                                                      > Nicole M. Mezni
                                                      >
                                                      > [Non-text portions of this message have been removed]
                                                      >

                                                      [Non-text portions of this message have been removed]

                                                      [Non-text portions of this message have been removed]





                                                      [Non-text portions of this message have been removed]
                                                    • Sunne
                                                      Nicole, You would submit your claim to the out of state address along with a copy of the EOB/RA from the primary payer. To identify your provider, they would
                                                      Message 26 of 29 , Oct 1, 2007
                                                      • 0 Attachment
                                                        Nicole,

                                                        You would submit your claim to the out of state address along with a copy of the EOB/RA from the primary payer. To identify your provider, they would use your BCBS provider number and/or your tax id number, both of which are on the claim form. They may also use your NPI.

                                                        nicole mezni <nmezni@...> wrote:
                                                        Thanks everyone for your responses.

                                                        I did notice on most of the out of state BC/BS cards, they do say to submit to your local BC/BS office. I will call just to make sure, but I think I'll be doing the same as you all do.
                                                        I really appreciate your help and input!

                                                        I do have one more question though, if the BC/BS plan is SECONDARY but it is out of state, do I still submit to the local? If not, what provider number would I use? The provider's local BC/BS ID?
                                                        Thanks again,
                                                        Nicole

                                                        ----- Original Message -----
                                                        From: debbie brosnan
                                                        To: MedicalBillers@yahoogroups.com
                                                        Sent: Wednesday, September 26, 2007 9:23 AM
                                                        Subject: Re: [MedicalBillers] Re: BCBS

                                                        Nicole,

                                                        Here is the rule. I live in Michigan. This is what I teach to my students.

                                                        1. No matter what state the patient is from as long as there is a 3 letter prefix in front of the contract number the claim is sent to the bc of the state services were rendered in.

                                                        2. This is a national bc policy I believe there are only 2 states that do not participate with the national bc policy. As long as there is an alpha prefix bill the state bc that services were provided.

                                                        With this in mind the patient has BCBSMI but services were rendered in Florida. THe claim goes to BCBSFL. You will be paid the bc of florida contracted rates not the out of state plan rates. If you are not paid the bc of florida contrated rates than you have to appeal the bc of florida for additional payment. bc of florida will inturn be reimbursed behind the scenes from michigan. I hope this helps you.

                                                        Have a great day. Its raining here in Michigan

                                                        Deb

                                                        nicole mezni <nmezni@...> wrote:
                                                        Okay cool...thank you Melinda! :)

                                                        Nicole
                                                        ----- Original Message -----
                                                        From: Melinda
                                                        To: MedicalBillers@yahoogroups.com
                                                        Sent: Wednesday, September 26, 2007 12:10 AM
                                                        Subject: [MedicalBillers] Re: BCBS

                                                        Nicole,

                                                        Here in WA State we are required to submit all out-of-area plans to
                                                        our local BCBS. The only time I submit directly to the plan is if
                                                        the Medicare cross-over didn't work, or if I have problems;
                                                        otherwise, I send it directly to BCBS.

                                                        Melinda Brown, CMBS
                                                        Ins Biller

                                                        --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@...>
                                                        wrote:
                                                        >
                                                        > When pts have BC/BS of Michigan, for example, but were treated in
                                                        FL, do we submit claims to the local BC/BS (FL)? Or do we submit to
                                                        MI? Or does this vary by plan?
                                                        >
                                                        > Thank you!
                                                        > Nicole M. Mezni
                                                        >
                                                        > [Non-text portions of this message have been removed]
                                                        >

                                                        [Non-text portions of this message have been removed]

                                                        [Non-text portions of this message have been removed]

                                                        [Non-text portions of this message have been removed]






                                                        Live well, love much, laugh often...

                                                        ---------------------------------
                                                        Fussy? Opinionated? Impossible to please? Perfect. Join Yahoo!'s user panel and lay it on us.

                                                        [Non-text portions of this message have been removed]
                                                      • s_alyssandra
                                                        Hello again Nicole, In New Jersey, out of state claims are still submitted to our local BCBS which is what they call the Blue Card. All out of state claims
                                                        Message 27 of 29 , Oct 2, 2007
                                                        • 0 Attachment
                                                          Hello again Nicole,

                                                          In New Jersey, out of state claims are still submitted to our local BCBS
                                                          which is what they call the Blue Card. All out of state claims goes to
                                                          one local address in New Jersey.

                                                          I had a patient who is BCBS GA and when I sent it to GA, it was a lot of
                                                          confusion. I called the GA BCBS, according to them I need to send it to
                                                          our local BCBS.

                                                          When it comes to appeals, and checking of benefits/eligibility --- I
                                                          always go with the number at the back of the card and I directly call
                                                          the state where the insurance card was issued.

                                                          If it is secondary and is also out of state, it's the same thing, we
                                                          submit it to our local BCBS. Here in New Jersey, we don't use a provider
                                                          number, we go by our TAX ID number. Ofcourse, you will be required to
                                                          enter all your NPI number.

                                                          Good luck!

                                                          Pinky
                                                          Owner
                                                          BillingCodingIsMyPassion! <http://www.justmypassion.com>


                                                          --- In MedicalBillers@yahoogroups.com, Sunne <sunne002@...> wrote:
                                                          >
                                                          > Nicole,
                                                          >
                                                          > You would submit your claim to the out of state address along with a
                                                          copy of the EOB/RA from the primary payer. To identify your provider,
                                                          they would use your BCBS provider number and/or your tax id number, both
                                                          of which are on the claim form. They may also use your NPI.
                                                          >
                                                          > nicole mezni nmezni@... wrote:
                                                          > Thanks everyone for your responses.
                                                          >
                                                          > I did notice on most of the out of state BC/BS cards, they do say to
                                                          submit to your local BC/BS office. I will call just to make sure, but I
                                                          think I'll be doing the same as you all do.
                                                          > I really appreciate your help and input!
                                                          >
                                                          > I do have one more question though, if the BC/BS plan is SECONDARY but
                                                          it is out of state, do I still submit to the local? If not, what
                                                          provider number would I use? The provider's local BC/BS ID?
                                                          > Thanks again,
                                                          > Nicole
                                                          >
                                                          > ----- Original Message -----
                                                          > From: debbie brosnan
                                                          > To: MedicalBillers@yahoogroups.com
                                                          > Sent: Wednesday, September 26, 2007 9:23 AM
                                                          > Subject: Re: [MedicalBillers] Re: BCBS
                                                          >
                                                          > Nicole,
                                                          >
                                                          > Here is the rule. I live in Michigan. This is what I teach to my
                                                          students.
                                                          >
                                                          > 1. No matter what state the patient is from as long as there is a 3
                                                          letter prefix in front of the contract number the claim is sent to the
                                                          bc of the state services were rendered in.
                                                          >
                                                          > 2. This is a national bc policy I believe there are only 2 states that
                                                          do not participate with the national bc policy. As long as there is an
                                                          alpha prefix bill the state bc that services were provided.
                                                          >
                                                          > With this in mind the patient has BCBSMI but services were rendered in
                                                          Florida. THe claim goes to BCBSFL. You will be paid the bc of florida
                                                          contracted rates not the out of state plan rates. If you are not paid
                                                          the bc of florida contrated rates than you have to appeal the bc of
                                                          florida for additional payment. bc of florida will inturn be reimbursed
                                                          behind the scenes from michigan. I hope this helps you.
                                                          >
                                                          > Have a great day. Its raining here in Michigan
                                                          >
                                                          > Deb
                                                          >
                                                          > nicole mezni nmezni@... wrote:
                                                          > Okay cool...thank you Melinda! :)
                                                          >
                                                          > Nicole
                                                          > ----- Original Message -----
                                                          > From: Melinda
                                                          > To: MedicalBillers@yahoogroups.com
                                                          > Sent: Wednesday, September 26, 2007 12:10 AM
                                                          > Subject: [MedicalBillers] Re: BCBS
                                                          >
                                                          > Nicole,
                                                          >
                                                          > Here in WA State we are required to submit all out-of-area plans to
                                                          > our local BCBS. The only time I submit directly to the plan is if
                                                          > the Medicare cross-over didn't work, or if I have problems;
                                                          > otherwise, I send it directly to BCBS.
                                                          >
                                                          > Melinda Brown, CMBS
                                                          > Ins Biller
                                                          >
                                                          > --- In MedicalBillers@yahoogroups.com, "nicole mezni" nmezni@
                                                          > wrote:
                                                          > >
                                                          > > When pts have BC/BS of Michigan, for example, but were treated in
                                                          > FL, do we submit claims to the local BC/BS (FL)? Or do we submit to
                                                          > MI? Or does this vary by plan?
                                                          > >
                                                          > > Thank you!
                                                          > > Nicole M. Mezni
                                                          > >
                                                          > > [Non-text portions of this message have been removed]
                                                          > >
                                                          >
                                                          > [Non-text portions of this message have been removed]
                                                          >
                                                          > [Non-text portions of this message have been removed]
                                                          >
                                                          > [Non-text portions of this message have been removed]
                                                          >
                                                          >
                                                          >
                                                          >
                                                          >
                                                          >
                                                          > Live well, love much, laugh often...
                                                          >
                                                          > ---------------------------------
                                                          > Fussy? Opinionated? Impossible to please? Perfect. Join Yahoo!'s user
                                                          panel and lay it on us.
                                                          >
                                                          > [Non-text portions of this message have been removed]
                                                          >



                                                          [Non-text portions of this message have been removed]
                                                        • debbie brosnan
                                                          Nicole, I still send to the home plan for my out of state 2nd. Only because of the 3 letter prefix rule. I usually dont have any problems getting paid.
                                                          Message 28 of 29 , Oct 2, 2007
                                                          • 0 Attachment
                                                            Nicole,

                                                            I still send to the home plan for my out of state 2nd. Only because of the 3 letter prefix rule. I usually dont have any problems getting paid. Every now and then BC of Illionis will hang up. And Empire I have problems with as 2nd to Medicare. But if you have been in billing for a long time we all know that Empire has been a sore spot for years. LOL.

                                                            Hope all is good with you. Where are you in Florida? My hometown is Crystal River.

                                                            Deb

                                                            nicole mezni <nmezni@...> wrote:
                                                            Thanks everyone for your responses.

                                                            I did notice on most of the out of state BC/BS cards, they do say to submit to your local BC/BS office. I will call just to make sure, but I think I'll be doing the same as you all do.
                                                            I really appreciate your help and input!

                                                            I do have one more question though, if the BC/BS plan is SECONDARY but it is out of state, do I still submit to the local? If not, what provider number would I use? The provider's local BC/BS ID?
                                                            Thanks again,
                                                            Nicole

                                                            ----- Original Message -----
                                                            From: debbie brosnan
                                                            To: MedicalBillers@yahoogroups.com
                                                            Sent: Wednesday, September 26, 2007 9:23 AM
                                                            Subject: Re: [MedicalBillers] Re: BCBS

                                                            Nicole,

                                                            Here is the rule. I live in Michigan. This is what I teach to my students.

                                                            1. No matter what state the patient is from as long as there is a 3 letter prefix in front of the contract number the claim is sent to the bc of the state services were rendered in.

                                                            2. This is a national bc policy I believe there are only 2 states that do not participate with the national bc policy. As long as there is an alpha prefix bill the state bc that services were provided.

                                                            With this in mind the patient has BCBSMI but services were rendered in Florida. THe claim goes to BCBSFL. You will be paid the bc of florida contracted rates not the out of state plan rates. If you are not paid the bc of florida contrated rates than you have to appeal the bc of florida for additional payment. bc of florida will inturn be reimbursed behind the scenes from michigan. I hope this helps you.

                                                            Have a great day. Its raining here in Michigan

                                                            Deb

                                                            nicole mezni <nmezni@...> wrote:
                                                            Okay cool...thank you Melinda! :)

                                                            Nicole
                                                            ----- Original Message -----
                                                            From: Melinda
                                                            To: MedicalBillers@yahoogroups.com
                                                            Sent: Wednesday, September 26, 2007 12:10 AM
                                                            Subject: [MedicalBillers] Re: BCBS

                                                            Nicole,

                                                            Here in WA State we are required to submit all out-of-area plans to
                                                            our local BCBS. The only time I submit directly to the plan is if
                                                            the Medicare cross-over didn't work, or if I have problems;
                                                            otherwise, I send it directly to BCBS.

                                                            Melinda Brown, CMBS
                                                            Ins Biller

                                                            --- In MedicalBillers@yahoogroups.com, "nicole mezni" <nmezni@...>
                                                            wrote:
                                                            >
                                                            > When pts have BC/BS of Michigan, for example, but were treated in
                                                            FL, do we submit claims to the local BC/BS (FL)? Or do we submit to
                                                            MI? Or does this vary by plan?
                                                            >
                                                            > Thank you!
                                                            > Nicole M. Mezni
                                                            >
                                                            > [Non-text portions of this message have been removed]
                                                            >

                                                            [Non-text portions of this message have been removed]

                                                            [Non-text portions of this message have been removed]

                                                            [Non-text portions of this message have been removed]






                                                            [Non-text portions of this message have been removed]
                                                          • bexx1232000
                                                            I work in Flint and teach at Ross Medical Education Center. I don t know of anyone hiring at the moment. Becki ... and teach at Jackson Community college. I
                                                            Message 29 of 29 , Oct 2, 2007
                                                            • 0 Attachment
                                                              I work in Flint and teach at Ross Medical Education Center. I don't
                                                              know of anyone hiring at the moment.

                                                              Becki


                                                              --- In MedicalBillers@yahoogroups.com, debbie brosnan
                                                              <thebiller_2000@...> wrote:
                                                              >
                                                              > Hi Becki,
                                                              >
                                                              > Glad to know there is a michigander in here. I live in Jackson
                                                              and teach at Jackson Community college. I also work for a surgery
                                                              center in West Bloomfield. I have a collegue that is looking for
                                                              reception work in the Flint area do you know of any?
                                                              >
                                                              > Where do you teach?
                                                              >
                                                              > Deb
                                                              >
                                                              > bexx1232000 <billing@...> wrote:
                                                              > Deb,
                                                              >
                                                              > I also live in Michigan, I'm outside of Flint and I also teach
                                                              medical
                                                              > billing. Where are you teaching?
                                                              >
                                                              > Becki Woodhams
                                                              >
                                                              > In MedicalBillers@yahoogroups.com, debbie brosnan <thebiller_2000@>
                                                              > wrote:
                                                              > >
                                                              > > Nicole,
                                                              > >
                                                              > > Here is the rule. I live in Michigan. This is what I teach to
                                                              > my students.
                                                              > >
                                                              > > 1. No matter what state the patient is from as long as there is a
                                                              > 3 letter prefix in front of the contract number the claim is sent
                                                              to
                                                              > the bc of the state services were rendered in.
                                                              > >
                                                              > >
                                                              >
                                                              >
                                                              >
                                                              >
                                                              >
                                                              >
                                                              > [Non-text portions of this message have been removed]
                                                              >
                                                            Your message has been successfully submitted and would be delivered to recipients shortly.