Questions? We’re here to help. Contact Us

Top Billing Issues and Errors and How to Avoid them for Professional Providers

Claims processing experts identified the common adjudication errors that cause claims to be suspended or denied. To ensure timely and accurate processing of claims please review these recommendations.

Some common issues…


Bilateral Procedures

When billing a bilateral procedure that requires a modifier, if done bilaterally use modifier 50 and bill one unit per left/right combination. Do not bill an RT and LT modifier separately. If multiple distinct bilateral procedures are done on a patient, for example, multiple bilateral spine injections, it is permissible to bill multiple units.

Incorrect Provider Number (NPI)

BCBSWY needs your correct NPI on file to process your claim properly. If practices are unsure which National Provider Identifier (NPI) to use, contact BCBSWY Provider Relations.

Incorrect Taxonomy code

Submit a valid taxonomy code, in box 24j on a HCFA 1500. For providers with multiple specialties please use the taxonomy code that reflects the services provided.

Invalid address or zip code

Submit the physical street address for the billing and/or service facility NOT PO BOX or Lock Box.

Submit all 9 digits of the billing and/or service facility zip code without zeros in the last four positions. Contact Provider Relations if your location does not have a +4 zip.

When billing for anesthesia and the billing provider is not a CRNA

One of the following anesthesia certification modifiers must be submitted: AA-AE, GC, QX, QY, WP

Related anesthesia procedure code not found for anesthesia service.

Submit surgery code for the Anesthesia being administered.

NPI for referring provider not found

For certain services (labs, imagining, DME) the NPI of the referring provider is required on the claim.

CCI Edits

Correct Coding Initiative (CCI) edits are now applied to BCBSWY claims. Payment for these services are included in the allowance for another service with which it was provided. These services cannot be paid separately.

Non-participating Provider Benefit Denials

This service is only covered when performed by a participating provider. Therefore, no payment can be made.

Line Item Missing Charges

Line items requires a provider charge.


Related Posts
Coding Advice: Claims Coding Tips For Faster Approval
Please note the following errors that often lead to claims denial when not properly coded: BCBSWY will deny Column II procedure codes billed with…
Availity: Prior Authorizations Go Live Next Monday
Prior Authorizations are Live on Availity Next Monday, September 18, 2023 You will soon be able to submit prior authorizations through Availity again. This…
Workflow and Updated Prior Authorization Guide Available
Online Prior Authorizations Submissions are unavailable until 9/18. Soon you can experience: More real-time information; Reduced wait times; Auto-approval of some authorizations. We appreciate…

Fewer Hassles. Better Service.