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Claim Reprocessing Requests; Mental Health and Substance Abuse

Claim Reprocessing Requests

As we enter our busy season, we want to remind providers that if you
receive a claim that is denied for “no authorization,” the quickest route of
reprocessing a claim for payment is to submit the missing authorization
through the standard authorization process. Please note that you are
submitting based on a denied claim on your cover page of documentation
or on your fax. Include the claim number.

Our clinical team will process the authorization and reprocess your claim
based on the review outcome. This will either allow your claim to be
processed for payment or provide you the appropriate appeal rights based
on the denial reason.

We recommend this method instead of submitting an appeal due to the
turnaround times. We would expect that your claim will receive an
authorization determination and claims reprocessing within 30 days. Note:
If submitting an appeal, the expected timelines could extend significantly
past 30 days.

Coding Advice

Mental Health and Substance Abuse

BCBSWY is not accepting billing of consolidation codes for mental health
and substance abuse such as G2087 and G2088. To receive
reimbursement for the different services listed under these codes, submit
the individual codes for the services rendered to the member.

These will be reviewed per the members benefit plan and reimbursed in
accordance with the BCBSWY fee schedule.


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