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Update Regarding Claims Issue With Lab, Vaccine, and Preventive E&M Codes

BCBSNC conducted system maintenance to ClaimCheck on July 13.  Unfortunately, the custom configuration to the application to pay claims according to our medical policy and billing guidelines did not migrate as planned during this upgrade.   As a result, claims with certain lab, E&M or vaccine codes that processed between July 13 and August 9 may have denied incorrectly.  A system fix was implemented that stopped many of the incorrect denials on August 9.

A remaining 400+ code combinations, primarily vaccine and preventive E&M services, required manual updating and validation and may have continued to deny incorrectly until September 7.  Any new claims with these codes received after September 8 will be processed correctly, although there may be a slight delay in payment as we are doing everything we can to ensure that the issue is corrected.

We are currently in the process of testing automation tools, which will help us expedite the reprocessing of these claims.  There is no need for providers to resubmit claims with these codes at this time.  We anticipate having target completion dates available regarding the reprocessing of these claims this week, and we’ll share those dates with you as soon as possible.

If you have any questions, please call the Provider Blue LineSM at 1.800.214.4844.