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Can't reach a human on the 800 851-7498 line and keep getting the "a Customer Advocate is not available" and that I can just hang up. Very frustrating. I sent a private message but I have no experience with this site as I am in the BCBS of Tennessee Network, locally. I really do need to speak to a person not the automated no help avatar because I need assistance with a denied claim requesting medical information which we can't provide. We provide ABA services. Our intial service code for assessment is 97151. Once we have completed assessment, we create a treatment plan. The denial is for needing 'medical records' the records you asked for?... a treatment plan. To be fair, you asked for office notes, the script from the doctor who referred or diagnosed the child and the treatment plan. I can provide the script but we have an authorization for the 97151 assessment already which we would have provided the doctor's script to you for that. We have the notes from the denied DOS that indicates assessment was ongoing. What we can't provide is a treatment plan because that is why you do assessments is to formulate a treatment plan at the end of the assessment period. So we were still IN the assessment period when the service was being provided on the denied dos. We can't provide a treatment plan for a dos that was not created yet. We then sought you out but we have had such a horrific time getting someone anyone who can take care of this or answer our question which is: Can a letter indicating that a treatment plan would not be available during an assessment period be acceptable or would you not need that after all? Can we please speak to someone who can direct us more? Local BCBS was like well, you need a treatment plan. We would rather not send the info to the local where it may sit in the computer waiting to be sent. we'd like to send whatever you are wanting directly to the Home plan ourselves. I am happy to provide the client info when I get the opportunity to speak with a living person at BCBS of Illinois. This is of course a Behavioral Health claim.
Hello, We have responded to your private message. ~ KW
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