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April 2013

Outpatient facility services benefit policy changes coming

Effective July 2013, BCBSM plans to make member benefit determinations by processing outpatient facility claims at the HCPCS level, for services that are required to be reported with a HCPCS procedure code.

Currently, benefits are determined at the revenue code level for all hospital outpatient services. Starting in July 2013, when a HCPCS code is not payable based on the group benefits, condition code or occurrence code, the nonpayable service will be rejected and become the member’s liability.

We do not anticipate any changes in the way outpatient facilities need to report services.

Look for more detailed articles and updates in upcoming issues of The Record

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