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Blues Plans Issuing Denials for Certain Modifiers

ACA has recently heard from members in a few states that some Blue Cross Blue Shield plans are automatically denying claims that contain the -25 and -59 modifiers. The states we have heard from to date include Illinois, Oklahoma and Texas. The Blues plans in these states are owned by Health Care Service Corporation (HCSC), an umbrella company that also owns the Blues plans in Montana and New Mexico. ACA has since learned that a new code-auditing enhancement is the source of the denials. 

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MACRA and MIPS: Getting the Big Picture

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) officially ushered in the value-based model of reimbursement, beginning a change to the payment landscape of American health care. But what does this mean to providers? What does it mean overall for you as a chiropractic physician? First of all, we shouldn’t be afraid of the deck being “reshuffled. Anytime there is a change in a system – especially a system that has delayed or avoided change – it becomes ripe for an innovative, landmark transformation.
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