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BCBS of MS allowed amount for Oral appliance(E0486) as of 2019 is $3.36!! Our office has been billing them for 2 years and we usually get paid a reasonable price around $2000-$1000 for our sleep apnea oral appliances. The only thing the Rep could tell me is to appeal all my claims. Is anyone else dealing with this? What should we do differently? Any tips or tricks? Edited by user Thursday, September 12, 2019 3:48:38 PM(UTC)
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Hi theoxfordcenter!
An allowed amount of $3.36 for E0486 sounds like a processing mistake to me!
I did have something similar happen to me with a BCBS a few years ago - they had processed E0486 through with an allowed amount of approx $150, and I appealed letting they know they MUST be missing a 0 in there because 1500 would be more like it :)
What happened in my situation is they claimed there was a data entry error on their end on their fee schedule, and the allowed amounts for E0485 and E0486 were flip flopped for a few months.
And yes, as the rep you spoke to mentioned - I would absolutely appeal, asking them to please re-process the claim with a more reasonable allowed amount because it appears they may have made a mistake. You can include language such as: "Even Medicare DME allows approx. $1100 in Mississippi for E0486".
I have also heard here and there an insurer would process E0486 through a lower allowed amount if the "NU" modifier is not present on the line item.
Hope this helps!
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通过跟留学生作业代写 http://www.wangkedaixiu.com/wkds/ 机构的在线客服的交流来对其专业性进行评判：回复是否准时、态度好坏，没有客服的机构直接排除。
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