December 11, 2013
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement Practice Management
Earlier this year, Blue Cross experienced a number of psychiatric service claims processing errors associated with the implementation of the new CPT codes for behavioral health services. Effective January 1, 2013, the American Medical Association (AMA) made more than 650 code changes to the CPT manual. Among those were significant changes to the psychiatry category, with the creation of new codes and guidelines as well as substantial code deletions.
The California Medical Association (CMA) received calls from psychiatrists regarding two concerns with the way their claims were being processed by Blue Cross. Some practices reported that when they submitted a claim for an Evaluation and Management (E/M) code with a psychotherapy add-on code, the Blue Cross system was deducting two copays – one on the E/M and one on the add-on code.
CMA raised these concerns with Blue Cross and was advised that the system problems had been corrected as of March 5 and that automatic reprocessing of affected claims would ensue. However, in the November Professional Network Update, Blue Cross advised providers that not all of the claims processing problems have been resolved.
Providers do not need to resubmit claims, as the reprocessing of the impacted claims will be automatic once the system is fixed. However, CMA encourages physicians to create an internal list of all affected claims to ensure that all claims are paid correctly, including applicable interest and penalties, once the system is fixed.
Physicians with questions can contact Blue Cross Network Relations at (855) 238-0095 or firstname.lastname@example.org.