Blue Cross Nebraska - deleting and returning claims

On our skin grafts, they are denying CPTs 15003 and 15005 for MUE edits ? units billed are considered excessive. Typically anything over 15 units is getting kicked out. When we have large burns of over 40% TBSA, it is very common to have skin grafts placed in excess of 2,000 sq cm or more.

They delete the claim number out of their system and return a letter stating to verify units and resubmit claim with op note. We do this, and they are still denying for units even with op notes. By the time we submit the 3rd time (given the 30-45 days delays of them replying to our submissions), it?s past time limit of 180 days and then they finally can deny the claim on the remittance as timely filing.

Ours may be a unique situation with the patients affected are all in the burn unit, but I am attempting to see if there are any other providers in Nebraska having this issue. We bill for the regional burn center so we get the large cases. Our denied claims are adding up quickly - well over $240K and attempting to work with our provider rep is getting us no where.

If anyone else is having this issue or something similar on other MUE edits AND you have been successful in getting this resolved, please let me know.

Melissa

Blue Cross Nebraska - deleting and returning claims