In January 2017, BCBS of South Carolina began incorrectly processing prostate biopsy claims containing more than 6 units of 88305. Units over 6 were not considered and the carrier instead provided a remark code CO45, which indicates a usual and customary discount per contract. Failure to report HIPAA compliant denial and remark codes for non-considered units of 88305 prompted electronic payment posting systems to adjust what should have been appealed for payment.
The carrier was made aware of this issue and has indicated there was a system error that was disallowing units billed over 6. The Director of Professional Network Contracting at BCBS SC indicated the system error has been corrected and presently the max units that will be processed and considered for payment is 14.
On behalf of its South Carolina clients, APS has identified all affected claims and submitted them for reprocessing. Further questions can be directed to your APS Practice Manager.
APS stepped in and took control of the transition and generated normal collections in our second month, improving billing, which is a huge accomplishment for our business.