Name of Manual - Blue Cross and Blue Shield of Minnesota

Claims Processed by Blue Cross
BlueCard®
Claims Notification Blue Cross will issue claims payment and notification directly to
you as a participating provider on our standard electronic
remittance advice (835) or by posting your remittance to provider
web self service. Statements have been sorted to provide a separate
section for BlueCard business for providers billing on the CMS-
1500 form or the 837P electronic format. For those providers
billing on the CMS-1450 (UB-92) or the 837I electronic format,
the claims will not be separated.
Your patients’ Explanation of Benefits (EOB) will be issued to
them by the home plan. Should there be a discrepancy between the
patient’s EOB and your remittance, please send a copy of both to
Blue Cross provider services for review.
Policies When a BlueCard claim is received by Blue Cross the following
procedures must be followed:
• Providers must comply with all standard contractual
procedures. Patients cannot be billed as follows, except as
otherwise allowed by law:
• prior to the submission of the claim
• for any contractual reductions, or
• prior to the finalization of their claims
• Providers will not be responsible, and patients may be billed,
for the following denials by the member’s plan:
• Investigative services
• Care management charges or penalties
• Medical necessity
• Non-covered services
• BlueCard program exempt services (stand-alone dental,
drug claims billed by a pharmacy)
Adjustments Contact us if an adjustment is required. We do need to work with
the member’s plan for adjustments; however, your workflow
should not be different. You may continue to contact Blue Cross
provider services for any questions or status on adjustments for
BlueCard claims.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (12/30/10) 7-13