Name of Manual - Blue Cross and Blue Shield of Minnesota

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Transfer Case (continued) Code Definition Claims Filing 43 Discharged/Transferred to a Federal Health Care Facility 65 70 Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital Discharged/Transferred to Another Type of Health Care Institution not Defined Elsewhere in this Code List Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12) 8-21
Claims Filing Single facility claim submission Blue Cross generally will not accept additional facility claims for the same encounter, normally referred to as late charges. To assure correct adjudication and payment of services, Blue Cross requires all related services to be submitted on the same single facility claim (837I). Late charges – A late charge refers to those claims that the provider is submitting after an admit-through-discharge claim or for the same encounter. A late charge contains charges omitted from the original bill and the charges are submitted as an add-on to the original bill. A late charge bill is not allowed according to the Minnesota Uniform Companion Guide for Institutional Claims. It is also not allowed for paper claim submission. Encounter – Encounter means an instance of direct provider/practitioner to patient interaction, in an outpatient facility setting, for the purpose of diagnosing, evaluating or treating the patient’s condition, and during which eligible health services are rendered to the member. Exceptions – Exceptions that may justify separate claims may include: Separate ER visits – separate emergency room visits on the same date of service Ambulance services Late charges – unrelated diagnosis: Outpatient charges with same date of service submitted as separate claims with unrelated diagnosis will no longer be denied as late charges. The duplicate review process has been updated with the following examples of exceptions to late charge (replacement claim) processing. Use these as a guide to determine if the claim situation meets the criteria as ‘unrelated’. 1. Patient has a mammogram, subsequently, in another department, the patient received chemotherapy (for other than breast cancer). 2. Patient receives therapy, subsequently, in another department, the patient has an electrocardiogram. 3. Patient is seen for a radiation therapy, subsequently, in another department, the patient is seen for routine screening. 4. Patient receives therapy and subsequently visits the ER for a unrelated condition (e.g., injury or acute illness unrelated to the therapy received) 8-22 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12)
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Blue Cross and Blue Shield of Minne
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Recent Chapter changes: Chapter 11
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Chapter 11 - Coding Policies and Gu
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Durable Medical Equipment Date Topi
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Medical Emergency Date Topic Change
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Rehabilitative Services Date Topic
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Table of Contents Chapter 1 At Your
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Introduction Provider Policy and Pr
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How to Contact Us At Your Service P
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At Your Service Claims Address Subm
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Care Management Numbers and Address
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Care Management Numbers and Address
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Company Phone Number Address Public
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At Your Service Provider Identifica
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ID Cards At Your Service Introducti
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Electronic Commerce Overview An imp
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Remote Access Services (continued)
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Provider Communications Provider Co
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Health Plan Members have the Follow
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Provider Agreements Participation a
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Provider Agreements Responsibilitie
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Provider Agreements Provider Number
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Provider Agreements Accounting for
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Provider Agreements Carrier Replace
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Table of Contents Chapter 3 Quality
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Quality Improvement Leadership Rati
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Quality Improvement Telephone Care:
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Quality Improvement Quality of Care
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Quality Improvement Written Policie
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Quality Improvement Written Policie
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Quality Improvement Patient Safety
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Quality Improvement Medical Record
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Quality Improvement Institute for C
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Quality Improvement Quality Improve
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Quality Improvement Physical Facili
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Quality Improvement Treatment Recor
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Integrated Health Management Progra
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Integrated Health Management Provid
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Integrated Health Management Utiliz
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Integrated Health Management Medica
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Integrated Health Management Overvi
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Integrated Health Management Pre-Ce
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Integrated Health Management Decisi
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Integrated Health Management Defini
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Integrated Health Management For Lo
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Integrated Health Management Appeal
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Integrated Health Management Case &
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Integrated Health Management Diseas
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Integrated Health Management Focuse
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Integrated Health Management Specia
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Integrated Health Management Overvi
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Integrated Health Management Sample
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Health Care Options Prepaid Medical
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Health Care Options Member ID Cards
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Health Care Options Blue Cross and
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Health Care Options Double Gold Dou
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Health Care Options Medicare Basic
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Health Care Options Platinum Blue S
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Health Care Options MedicareBlue PP
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Health Care Options Inquiries and C
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Health Care Options Additional info
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Health Care Options Minnesota Senio
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Health Care Options MinnesotaCare P
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Health Care Options BlueLinkTPA Blu
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Health Care Options Delta Dental Hi
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Health Care Options Prime Therapeut
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Health Care Options Workers' Compen
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Health Care Options HICF 1500 Form
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Health Care Options Networks Blue C
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Blue Plus Member Information Introd
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Blue Plus Member Rights and Respons
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Blue Plus Member Rights and Respons
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Blue Plus Member Benefits Members
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Blue Plus Quality of Care Complaint
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Blue Plus Referral Points Remember
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Blue Plus Referral Not Required We
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Blue Plus Standing Referral Minneso
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Blue Plus Clarifications of Terms (
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Blue Plus [Date] [Name of patient]
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Blue Plus Special Member Benefits O
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Page 173 and 174: BlueCard® Claim Status Inquiry ...
Page 175 and 176: BlueCard® Identifying BlueCard ®
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Page 179 and 180: BlueCard® BlueCard Service Claims
Page 181 and 182: BlueCard® Prior Authorization and
Page 183 and 184: BlueCard® Electronic Data Intercha
Page 185 and 186: BlueCard® Claims Processed by the
Page 187 and 188: BlueCard® Overview (continued) 3.
Page 189 and 190: BlueCard® Claim Payment Guidelines
Page 191 and 192: BlueCard® Calls from Members and O
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Page 195 and 196: BlueCard® Types of Medicare Advant
Page 197 and 198: BlueCard® Medicare Advantage Claim
Page 199 and 200: BlueCard® Reimbursement for Medica
Page 201 and 202: Claims Filing HCPCS/ Accommodation
Page 203 and 204: Claims Filing Administrative Simpli
Page 205 and 206: Claims Filing Claims with Attachmen
Page 207 and 208: Claims Filing Claims with Coordinat
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Page 211 and 212: Claims Filing 1500 HICF Form Profes
Page 213 and 214: Claims Filing Ordering Forms and Ma
Page 215 and 216: Claims Filing Site of Service (cont
Page 217 and 218: Claims Filing Institution (837I) /F
Page 219: Claims Filing Treatment Room Blue C
Page 223 and 224: Claims Filing Present on Admission
Page 225 and 226: Claims Filing Medicare Crossover Bl
Page 227 and 228: Claims Filing Cancel/Void and Repla
Page 233 and 234: Claims Filing Verifying Patient Eli
Page 235 and 236: Claims Filing Basic Character Set V
Page 237 and 238: Claims Filing Rural Health Clinics
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Page 241 and 242: Claims Filing TEFRA The 1982 Tax Eq
Page 243 and 244: Claims Filing Employment As defined
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Page 261 and 262: Appeals Provider Appeals Introducti
Page 263 and 264: Appeals Submitting Requests for Pos
Page 265 and 266: Appeals Coding Appeals (continued)
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Coding Policies and Guidelines (Cod
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Coding Policies and Guidelines (Mod
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Chapter 11 Coding Policies and Guid
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Part-time (Medically Directed) Anes
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Electroconvulsive Treatments Blue C
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Moderate (Conscious) Sedation Monit
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Coding Policies and Guidelines (Beh
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Coding Restrictions Code Restrictio
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CTSS Skills Training and Developmen
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Intensive Residential Treatment Ser
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IRTS Member Eligibility IRTS Access
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Adult Non-Residential Crisis Servic
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MH-TCM Services to Minnesota Health
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Dialectical Behavioral Therapy/DBT
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Autism Spectrum Disorder/EIBI (cont
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Autism Spectrum Disorder/EIBI (cont
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Psychiatric Consultation to Primary
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Psychiatry and Chemical Dependency
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Medication Management M0064 and 908
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Nutritional Counseling/Medical Nutr
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Practitioner Key MD = Psychiatrist
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Clinical Supervision Under Minnesot
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DIAMOND Initiative (continued) Reim
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Missed Appointments (continued) Cou
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Guidelines for Court Ordered Evalua
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Guidelines for Court Ordered Evalua
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Behavioral Health Quality Improveme
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Coding Policies and Guidelines (Den
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Prior Authorization Requirements Co
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Coding Policies and Guidelines (Dur
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Waivers and Upgraded/Deluxe DME Wai
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Hearing Aids (continued) Website Co
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Portable Oxygen Billing (continued)
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DME/Supply Internet Purchases Codin
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Coding Policies and Guidelines (Hom
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Elderly Waiver Program (continued)
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Referrals and Prior Authorization (
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Referrals and Prior Authorization (
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Adult Day Care Bath Services Coding
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Home Infusion (continued) Coding Po
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Coding Policies and Guidelines (Hom
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Rules and Regulations (continued) H
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Hospice Billing for Medicare Produc
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Coding Policies and Guidelines (Hos
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Coding Policies and Guidelines (Lab
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Papanicolaou Smears (continued) Dia
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Coding Policies and Guidelines (Mat
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Coding Policies and Guidelines (Opt
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Coding Policies and Guidelines (Pha
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Drugs Coding Policies and Guideline
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Drug Programs Coding Policies and G
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Coding Policies and Guidelines (Pub
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Physical Therapy Evaluation Codes C
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Hot and Cold Pack Exclusion TMJ Ort
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Massage and Manual Therapy Exclusio
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MHCP PT, OT, ST Authorization Proce
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Bilateral Services (continued) Codi
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Coding Policies and Guidelines (Sur
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Acne Treatment/ Skin Rejuvenation a
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Liposuction Edit Change Coding Poli
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Assistant Surgeons (continued) Assi
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