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  • Writer's pictureRose Sims

BCBS and Denials and Appeals! Oh My!

Updated: Aug 13, 2020

Having trouble with BCBS?

I've got answers!


If you are in the state of Florida or your state’s local BCBS is like ours, you know that since COVID-19 changed our lives in March, BCBS is not taking claims calls. Period. No calls. Even after all these months.

So how do you reach BCBS to handle denials, work claims and follow-up on appeals?

The answer is Availity’s secure messaging system. BCBS has upgraded their Availity interface to include a messaging system. It’s actually pretty simple. You run a claim status search, locate the claim and from there now have the option to submit a message regarding the claim.

BCBS states it will take up to 7 business days to get back to you regarding the claim. In true BCBS fashion they often do not get back to you in the stated amount of time. So you want to really be on top of your follow-up. Many of the responses you get will be through traditional snail mail - make sure to keep an eye on your correspondence!

You can also submit appeals/reconsiderations and documentation through this messaging system. Be sure to always include the appropriate appeal/reconsideration form when submitting documentation (such as medical records, chart notes, authorizations, etc.).

BCBS is notorious for receiving documentation and letting it sit in a desk drawer somewhere in the universe. Including the appeal/reconsideration form is to ensure BCBS reprocesses the claim accordingly. And again, follow-up is so key in receiving reimbursement in a timely manner that it cannot be stressed enough.

If you are having trouble with your BCBS billing don’t wait! Get the help you need! You work hard and deserve payment for the good service you provide your patients. I recommend obtaining the services of a billing specialist or, if you have in-house billing, getting a consultant in to debug your billing. If you need help, I’m here for you.

Yours in health,

Rose Sims

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