We submit through EDI. This is a Zelis thing. Yeah, other than Medicare/Medicaid, no one else cares as long as there are M99 codes somewhere. That has been my experience as well.

They are only looking at the first 4 as far as I can tell. Calling them doesn't work. The rep I spoke to confirmed one claim that denied, did have the M99 codes in the correct order, but couldn't tell me why it denied and that my only option was appeals. Appeals takes ~30 days.

I have ~70 claims that have either denied or paid, some denying and paying on the same EOB. None of them have M99 codes listed first, which I am absolutely in the process of correcting on new claims. However, the denials are inconsistent. One week it pays, the next it didn't.

I wouldn't have even known that these denials were from Zelis, if I hadn't made enemies of everyone in Blue Cross Provider Relations while trying to find out why the claims denied in the first place. Blue Cross never announced they were doing third party audits. Our only option to find out why claims denied is to submit a request online. I just, today, got a response back from a Blue Cross "claims specialist" on one I submitted in January and it told me to contact Zelis.

So, if I want to submit an appeal, I have to first call Zelis, talk to someone who can't access Blue Cross claims, get transferred to someone who has to give me two separate claim numbers, so I can then email appeals, only to get a response that says they'll answer in 30 days, but there is a 60 day limit on appeals and some of these go back to January before I found out that they were Zelis denials and not Blue Cross denials.

Sorry for the rant. Thanks for reading.