Blue Cross and Blue Shield of Texas (BCBSTX) is currently identifying and reprocessing certain flu testing claims that were incorrectly denied, as the Texas Medical Association's Physician Payment Resource Center (PPRC) has learned in correspondence.
BCBSTX explained in correspondence with TMA’s PPRC – which reached out for clarification earlier this month on the payer’s new flu testing policy – that some claims for certain labs, including those offering flu testing, were unintentionally denied due to a vendor error. The health plan began again processing claims accurately Feb. 14.
TMA’s Director of Physician Payment Services Carra Benson says physicians do not need to take action to receive payment. However, she recommends physicians review flu testing claims filed between Jan. 1 and Feb. 13 to ensure correct reprocessing.
BCBSTX is identifying all unintended denials and will reprocess claims accordingly. If errors persist, physicians can reach out to both BCBSTX and TMA’s PPRC for assistance.
Ms. Benson says physicians also should look at BCBSTX’s flu testing policy, effective Jan. 1, and document appropriately alongside the associated codes. BCBSTX included a list of code numbers related to the guidance – 87804, 87400, 87501, 87502, 87503, 86710, 87275, 87276, 87631, and 87254 – though the insurer cautioned this was “not an all-encompassing code list.”
Per BCBSTX’s guidance, payment eligibility is contingent on the tested patient exhibiting symptoms such as a fever of 100.4 F (38.0 C) or above, or feeling feverish or chills, plus at least one of six other symptoms:
- Headaches and/or body aches;
- Difficulty breathing or shortness of breath;
Meanwhile, the Texas Department of State Health Services (DSHS) is still enlisting physicians’ help in its enhanced flu surveillance, including monitoring for the H5N1 variant of the influenza A virus. TMA staff confirmed samples collected for DSHS are treated separately, and BCBSTX denials won’t affect DSHS processing or impart additional charges to physicians.
Physicians who wish to participate in the state’s sample collection project should contact Carolyn Crisp, a Centers for Disease Control and Prevention career epidemiology field officer at DSHS.
Visit the PPRC page on the TMA website to request help with denied claims and check out its billing and coding tips for physicians.
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469