Guest guest Posted November 2, 2005 Report Share Posted November 2, 2005 Listserv, Did anyone else have time to review the new BCBS provider packet sent out last week? I was looking at page 5 E. and H. These deal with services not covered and Refunds. I submitted questions on these 2 points and wonder if anyone else did the same? Under E. if a service is deemed 'not medically necessary' then BCBS will not pay and you must agree not to charge the patient. I have asked who is on the peer review to determine medical necessity. How many and what are their degrees? I'll let you know when I get a response. I also asked about refunds. because the contract says that if an overpayment or incorrect payment is made, they can request reimbursement for up to 12 months after date of service on the over payment and 48 months on the double payment. I asked if that means that we as providers must know more about the policy than the claims analysts that approve payments? It might help if others inquire as well on these or any issues you are concerned about. If we ask for answers in writing and educate each other, we may be less apt to have trouble later. Minga Guerrero DC Gresham OR Quote Link to comment Share on other sites More sharing options...
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