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PAP202

Claim Submission Requirements


Provider Administrative Policy

Section
Claims Submission
Policy Date
February 2008
Status/Date
Revised/August 2014
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

Claim Submission Requirements

Please refer to the table below for the billing format required when submitting claims for the given provider type.

Provider Type CMS1500 UB-04 CPT ICD9 Rev ICD
Advanced Practice Nurses    
Ambulance - hospital based  
Ambulance - non-hospital    
Approved Diabetic Education Programs
Hospitals    
Clinic based providers    
Audiologists    
Chiropractor    
Counselor (LCPC)    
CRNA    
Diagnostic Imaging    
DME    
Home IV    
Home Health prior to 01/01/2010 •     
Home Health effective 01/01/2010  
Hospice    
Inpatient Hospital    
Outpatient Hospital  
Professional Hospital    
Licensed Marriage and Family Therapist (LMFT)    
Lithotripsy    
Nurse Practitioner    
Occupational Therapist    
Physician    
Physician Assistant    
Physical Therapist •*    
Podiatrist    
Psychiatric Inpatient    
Psychiatric Professional    
Psychologist    
Registered Dietician

 •

 

 •

 
Service Extender    
Skilled Nursing Facility (SNF)    
Sleep Laboratory

 

• 

 
Social Worker (LCSW)    
Speech Therapist    
Surgery Center    
Vision    

* Physical therapy claims billed to Blue Cross of Idaho that are secondary to Medicare should be billed on a UB-04 if instructed to do so by Medicare. All covered providers are contingent on the member`s contract.

Claims Mailing Address
P.O. Box 7408
Boise, ID  83707

Blue Cross of Idaho does not accept claims submitted on a CMS 1500 Claim Form with a combination of CPT procedure codes and CDT codes. We will return claims received with a combination of codes for correct coding. Claims billed with CDT codes must be submitted on an ADA Dental Claim Form to the address on the member's insurance card. BlueCard claims processing guidelines will not allow claims billed with CDT codes to be processed through the local plan.


Policy History

Date Action Reason
August 2014 Revised Added language regarding CDT codes submission on ADA claim form
November 2010 Revised Added sleep labs and registered dieticians
January 2010 Revised Home health billed on UB04
May 2008 Revised Grid revised

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