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Submission of Missing Charges or Corrected Claims for Hospitals


Provider Administrative Policy

Section
Hospital
Policy Date
November 2007
Status/Date
Reviewed/May 2008
Provider Type(s)
Hospitals  

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

Submission of Missing Charges or Corrected Claims for Hospitals

DRG Hospitals
All DRG hospital charges, including outpatient charges, related to a single patient visit should be included on the initial claim. If a claim is received for missed or additional charges, the claim will be returned to the provider. Since the DRG payment is a flat rate based on diagnosis, the payment would not change with the additional charges in most cases

DRG hospital claims will only be adjusted if we receive a corrected billing for one of the following reasons:

  • DRG code or allowance changes
  • Liability changes for the member or Blue Cross of Idaho

Non-DRG Hospitals
All hospital charges related to a single patient visit should be included on the initial claim. If additional claims are received for missing or incorrect charges they must be submitted with the appropriate bill type code on the UB-04 form to indicate a corrected claim. Further, corrected claims must be inclusive of all charges, not only the missed or corrected charges.


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