Telehealth Denial with place of service
Answered
I have been submitting and received funds when using place of service code 11(office setting) and modifyer 95 for telehealth sessions for multiple insurance companies. We were instructed to do so near the beginning of COVID. This month multiple claims were denied. I can not find any articles stating that (especially BCBS) insurance companies have now gone back to requesting we use 02 (telehealth) .
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finally found this: in case its helpful to anyone else. at least BCBS of alaska is no longer using 11 for telehealth.
Updates as of October 9, 2020
- See our new section with all COVID-19 key dates for coverage and benefits.
- Earlier this year, Premera made the decision to hold overpayment recoupments due to the pandemic and the effect it was having on our provider offices. We will now begin recouping those overpayments. If you were overpaid for a claim, you will receive a statement indicating the amount of overpayment. The notice will include instructions on how to repay any amount owed back to Premera.
- Premera will be extending the payment of telehealth visits at the in-person allowed amount, during the national public health emergency, beyond September 2, 2020 as previously communicated. For providers who are delivering services via telehealth, Premera will require providers to continue use of the correct telehealth place of service (POS) 02 with the procedure code appended with either modifier 95 or GT. Claims with modifiers indicating they were telehealth, if billed with POS 11, will be rejected up front and will require the correct POS to match the service billed. We will no longer accept POS 11 for telehealth services. Refer to your Premera contract for allowable information for virtual care codes. For specific coding information for Premera patients, see our telehealth payment policy for Alaska.
- Premera is waiving cost shares for all COVID-19 related testing and treatment. Learn more.
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Thanks for the update Noah! To change the Insurance Place of Service for a Office Location in SimplePractice, go to Settings > Practice Details, scroll down to the Office Locations section and make the change. I'd like to note that the Place of Service requirements may differ for other insurance payers and the best way to verify this is by reaching out to the payer directly, as you did. Thanks again!
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BCBS also informed me that office Address (Box 32) is also required. I'm not sure why it's not prefilled, possibly because Simple Practice knows I'm doing telehealth. Provider support told me that could cause their system to automatically deny a telehealth claim. Not sure if this helps anyone.
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