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PAP354

Independent Air/Ground Ambulance Billing


Provider Administrative Policy

Section
Ancillary Provider
Policy Date
August 2010
Status/Date
Revised/March 2015
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

Independent Air/Ground Ambulance Billing

Independent air/ground ambulance providers (participating or non-participating) need to submit claims on a CMS1500 claim form.  Box 32 needs to include information about site of pickup/delivery. 

Services for Blue Cross of Idaho members

  • Independent air/ground ambulance providers must be licensed and have a service address in the state of Idaho.
  • If pickup and delivery sites are both in the state of Idaho, please submit your claims to Blue Cross of Idaho.
  • If contracting with Blue Cross of Idaho and service address is located in a contiguous county, please submit your claims to Blue Cross of Idaho.

Services for FEP members

  • We base claims for ambulance services on the provider's contract status with the plan at either the pick up or drop off location.
  • If the ambulance provider is not contracted with either plan, the claim should be submitted to the plan where the member was picked up.
  • If the provider is contracting with both plans, submit the claim to the plan where the member was picked up.
  • If pickup and delivery sites are both in the state of Idaho, submit your claims to Blue Cross of Idaho. Please submit claims for areas south of Riggins to Blue Cross of Idaho, and claims north of Riggins to Regence Blue Shield of Idaho.

Services for Blue Card members

  • If the ambulance providers are based/coordinated in the State of Idaho, and the site of services are in Idaho, please submit claims to Blue Cross of Idaho regardless of contracting status.
  • If the ambulance providers are based/coordinated in the State of Idaho and the pick-up/delivery site crosses the state line, please submit claims to Blue Cross of Idaho.

Exception: In certain circumstances, ambulance providers must submit their claims to the plan located where the incident took place, the plan in the state in which the ambulance is headquartered, or the plan in the state where services were coordinated. All of the following conditions must be met for this to occur:

  • The ambulance provider does not have a service location in Idaho, and
  • Services are not coordinated by an Idaho-based provider, but the services are either fully or partially rendered in Idaho.

Air Ambulance

Effective May 18, 2015, air ambulance providers must file claims to the local plan where the pick-up occurred and include the ZIP code in the claim. Exception: For Blue Cross of Idaho members, if the point of pick-up is located in a contiguous county and the air ambulance provider is contracting with Blue Cross of Idaho the claim should be filed direct to Blue Cross of Idaho and processed in-network. We use ZIP codes to validate based on the following CMS guidelines:

  • In item 23 of the CMS-1500 Health Insurance Claims Form, or the equivalent field of the X12N Health Care Claim - 837 Professional, billers shall enter the five-digit ZIP code of the point of pick-up. If the point of pick-up ZIP code is not in Blue Cross of Idaho's service area, the claim will be rejected.
  • Claims without a point of pick-up ZIP code, or with multiple ZIP codes, will be rejected.
  • The format for a ZIP code is five-digits. If a nine-digit ZIP code is submitted, the last four digits are ignored. If the data submitted in the required field does not match that format, the claim will be rejected.

Policy History

Date Action Reason
March 2015 Revised Added air ambulance exception
February 2015 Revised Added language regarding air ambulance.
June 2014 Revised Language clafirication on services for FEP members.
May 2013 Revised Updated BlueCard section, language clarification under Exception:

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