Name of Manual - Blue Cross and Blue Shield of Minnesota

Workers'
Compensation, No-
Fault Auto &
Subrogation
(continued)
HICF 1500 Form Locator 837P
Health Care Options
11. What are some uncommon injuries that maybe covered by
the automobile or third party insurance?
The automobile or third party insurance may cover injuries that
occur while the individual is at someone else’s home, on
someone else’s private property, at a place of business, due to a
dog bite, or when they are a pedestrian or bicyclist injured by a
motor vehicle.
12. Does health insurance coordinate with auto/third party or
workers’ compensation insurance?
No. In most circumstance the other insurance is primary. Once
the other insurance carrier has exhausted their payments,
claims may be payable under the health insurance policy.
13. Who should claims be filed to if the patient is working and
has an auto accident?
The claims should first be filed to the workers’ compensation
carrier. If they deny stating the employee was not in the scope
of their employment, then the claim should be filed to the auto
insurance carrier. If the auto insurance carrier denies or
benefits are exhausted, the claim should be billed to Blue Cross
with a copy of both the workers’ compensation denial and the
auto carriers exhaust letter, EOB, or payment log.
14. What should be done if a claim was paid by both Blue
Cross and another insurance company?
Option 1: Request a void/replacement claim. Refer to Chapter
10 for information regarding submission of void/replacement
claims. Note that effective July 15, 2009, only out of state,
nonparticipating providers are allowed to submit paper claim
forms per Minnesota Statute 62J.536 and the Blue Cross
provider contracts.
Information indicating if the patient’s condition is related to
employment, auto or other accident, or workers‘ compensation
should be indicated on the replacement claim.
For professional claims (HICF-1500 or 837P) complete the
items indicated below.
Item # Title Loop ID Segment Notes
10a Is Patient’s
Condition
Related to:
Employment
2300 CLM11 Titled Related Causes Code in
the 837P
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10) 5-31