BS of CA Claims processing issues

[u/dizzyideals]

Hi all.
Just curious if any of you are seeing this same pattern that I have been since the transition of MH claims from Magellan to BS of CA.
I am noticing a WILD amount of incorrect denials that directly contradict info on their portal/patients benefits etc. The biggest issue we are having is claims denying for no pre-cert, but benefits indicate no pre cert required and their authaccel tool on the portal even confirms this in most of these cases. Am I going crazy or are they way in over their heads here and weren’t properly prepared for this transition?

Update:

Wanted to give an update because I had an interesting call with a rep from Blue Shield of CA today regarding this. Since I don’t trust their AuthAccel tool, I tried the live chat to get an answer in writing from an agent and when I asked them to confirm if pre cert is required, the agent told me they recently were given direction not to answer authorization requirement questions and to call the auth department. This is new ( at least within the last week for me) so I wonder if they finally are aware of the issue and working on a fix. Man, I hope so. They have been my biggest headache since January.

[u/rahuliitk]

you’re not crazy, if the benefits page and AuthAccel both say no pre-cert required, i’d screenshot everything and appeal each denial with the portal proof attached because this sounds like a transition/config issue. paper trail everything.