Name of Manual - Blue Cross and Blue Shield of Minnesota

Claims Filing
HCPCS/ Accommodation Rates/HIPPS Rate Codes (FL 44)..............................................8-19
Duplicate Billing..................................................................................................................8-19
Treatment Room ..................................................................................................................8-20
Observation Room ............................................................................................................... 8-20
Clinic Charges......................................................................................................................8-20
Transfer Case .......................................................................................................................8-20
Single facility claim submission ..........................................................................................8-21
Zero Billed Charges .............................................................................................................8-22
Lactation Education .............................................................................................................8-22
0636 Drugs Requiring Prior Auth........................................................................................ 8-22
Present on Admission (POA)............................................................................................... 8-22
Claims Filing............................................................................................................................. 8-24
Timely Filing .......................................................................................................................8-24
Claims Crossover for Medicare and Medicare Supplement ................................................ 8-24
Medicare Crossover ............................................................................................................. 8-25
837I Crossover Information................................................................................................. 8-25
837P Crossover Information................................................................................................ 8-25
Duplicate Claims.................................................................................................................. 8-26
Submission of Claims .......................................................................................................... 8-26
Cancel/Void and Replacement Claims ................................................................................ 8-27
Release of Medical Records.................................................................................................8-32
Provider Assistance Requested............................................................................................ 8-32
Medical Records Management Process Improvement.........................................................8-32
Verify Member Identity .......................................................................................................8-32
Verifying Patient Eligibility................................................................................................. 8-33
Basic Character Set Values in the Electronic Transaction................................................... 8-34
Claim Service Dates Restricted to Same Calendar Month .................................................. 8-35
Reporting MNCare and Sales Tax ....................................................................................... 8-36
Rural Health Clinics and Federally Qualified Health Centers............................................ 8-37
Billing for Medicare Primary............................................................................................... 8-37
Billing Other Than Medicare Primary .................................................................................8-37
Coordination of Benefits (COB) ............................................................................................. 8-38
Overview..............................................................................................................................8-38
Primacy Determination ........................................................................................................ 8-38
Coordination of Benefits Types .............................................................................................. 8-39
Workers’ Compensation ...................................................................................................... 8-40
No-fault Auto.......................................................................................................................8-40
Subrogation..........................................................................................................................8-40
TEFRA.................................................................................................................................8-41
DEFRA ................................................................................................................................8-41
COBRA................................................................................................................................8-41
OBRA ..................................................................................................................................8-41
Non-Physician Health Care Practitioners ............................................................................. 8-42
Introduction..........................................................................................................................8-42
Eligibility Criteria ................................................................................................................8-42
Definitions............................................................................................................................8-42
8-2 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12)