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CPAP and Blue Cross GA
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10/18/2016 at 1:06:35 PM GMT
CPAP and Blue Cross GA

Are any other GA  providers having problems with cpap reimbursement from bc/bs of ga?

We are experiencing some issues and are getting the run around.......1st response saying a glitch, 2nd saying they are now rental items, 3rd will not give correct modifier with 1st month rental submission. Curious if we are the only ones.......anyone else? 

10/18/2016 at 1:10:58 PM GMT
Posts: 1
Hey Chad - I spoke with Angie about this. We were having the same problem and they kept giving us the run around as well, but we figured out that the humidifier was the problem on the claim. They wanted it as a rental. Seems to have corrected the problem. We do all Cpaps to BCBS as a rental and the humidifier was on the same claim on the initial issue, but it was on there as a purchase and BCBS wants it as a rental. Hope this helps.

10/18/2016 at 1:54:33 PM GMT
Posts: 1
We are also having a few issues with cpap/bipap coverage with Blue. Our issues are usually when the account falls under AIM sleep management. They don’t seem to follow the policy consistently which makes it difficult to determine initial coverage. We are often given a denial requiring the ordering physician to call in within 24 hours of the request to do a peer to peer for reconsideration. If the MD is not available in that short time frame our request is denied often causing us to start over with a new 24 hour window.  Those are the issues I am seeing. 

10/19/2016 at 11:24:59 AM GMT
Note from our team.

They do give the run around a lot. And No, they will not tell you what modifier to bill with. We only use RR, and bill up to the 10th month at which time it is capped/converted to sale.
The only other time different modifiers are used are when the contract of a specific patient has a Medicare replacement plan. Then the Medicare modifier combination is used
1st month- RR KH
2nd and 3rd month- RR KI
4th – 10th month -RR KJ
Hope this is helpful

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