Name of Manual - Blue Cross and Blue Shield of Minnesota

Claims Filing
Zero Billed Charges Blue Cross will allow zero-billing or no charge submission lines
on claims.
Lactation Education For billing purposes, lactation services are considered to be part of
the mother’s charges and should not be billed on the newborn’s
claim.
0636 Drugs Requiring
Prior Auth
Present on Admission
(POA)
Submit all claims for lactation education on the 837I claim form
using revenue code 0942. These charges must be submitted on the
mother’s original maternity/delivery claim and require a narrative
description.
Claims for lactation services submitted under the infant’s name or
number will be rejected.
If lactation education is necessary after discharge, it can be billed
as part of the post-partum visit under the mother’s identification
number.
Revenue code 0636, by definition, is for drugs requiring detailed
coding. A HCPCS code must always be submitted with 0636.
However, some drugs that may be submitted under this revenue
code also require prior authorization. The following are examples
that require prior authorization:
IVIG
Aminolevulinic Acid
Factor products
Blue Cross requires the present on admission (POA) indicator on
all claims (Medicare and commercial, including the
MedicareBlue SM PPO [Regional PPO] claims, Platinum Blue SM
[Cost], SecureBlue SM [HMO SNP], CareBlue SM [HMO SNP] and
Blue Advantage) for inpatient admissions to general acute care
hospitals.
General Reporting Requirements
The POA indicator is required for all claims involving
Medicare and commercial inpatient admissions to general
acute care hospitals.
The POA indicator is assigned to principal and secondary
diagnoses.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12) 8-23