BCBSM/AIM Wrongful Denials For Prior Authorizations
MSHO has been working closely with numerous members trying to resolve ongoing issues with denials for “no authorization” when, not only was an authorization obtained, it was also on the claim correctly. Appeals have also been unsuccessful in most cases. BCBSM has posted on webDenis that the issues have been resolved but that is not the case.
Below you will find an update from BCBSM received late Friday. We will continue working this issue and will keep our members updated as we have more information.
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BCBSM Response/Update:
“We have found that due to a systems issue, the authorizations from AIM for certain drugs stopped transmitting into our e‑referral system in December 2020. We are working on a solution that we hope to implement in early May. This solution will allow our claims systems to locate the authorization approvals and pay the claims.
There will be more communications surrounding this issue and I’ll be sure to let you all know. The problem is affecting medical oncology drug claims for:
We apologize for the inconvenience and thank you for your patience. However, in the meantime, should you have claims involving Medicare Plus Blue that are affected by this issue, please forward them to the following mailbox until further notice MASRX@bcbsm.com.
Please contact your provider representative for more information.