The Record - Updates announced for how DME suppliers, independent labs should submit claims

Updates announced for how DME suppliers, independent labs should submit claims

Find out where to file ancillary claims

To assist independent laboratories, DME suppliers and specialty pharmacies with filing claims, we’ve posted a link on web-DENIS.

The link provides a directory of addresses where they can submit claims for various Blues plans.
To find the link:

Go to web-DENIS.
Click on BCBSM Provider Publications and Resources.
Click on Newsletters & Resources.
Under Operations and Training, select Other BCBS Plan Claim Addresses.

When the Blue Cross and Blue Shield Association revised its rules for filing ancillary claims in certain situations, we discussed the changes in an article in the November 2012 edition of The Record.

Now, we’d like to inform you of updates to those guidelines for submitting claims. The changes affect independent laboratories and durable medical equipment suppliers.

You can use the table below as a reference, and the changes are indicated with an asterisk:

Provider type

Where to file

Fields to use when filing a claim

Examples showing which Blue plan to submit claims to

Durable medical equipment supplier
Types of service include
hospital beds, oxygen tanks, crutches, diabetic supplies, etc.

File the claim with the plan in whose state the equipment or supplies were shipped to or purchased in a retail store.
Note: For items purchased in a retail store, use place of service “11” for commercial claims. If your claim is rejected, please contact Provider Servicing. We are currently working to update our system to ensure that location 11 is accepted as a payable location. For Medicare primary and Medicare Advantage claims, CMS billing guidelines apply.

Patient’s address:
Make sure to indicate the address of where the DME is shipped to or purchased, using the following fields:

Field 5 on the CMS-1500 claim
Loop 2010CA on the 837 professional electronic claim

Ordering/referring provider:

Field 17B on the CMS-1500 claim
Loop 2420E (line level) on the 837 professional electronic claim

Place of service:

Field 24B on the CMS-1500 claim
Loop 2300, CLM05-1 on the 837 professional electronic claim

Service facility location information:
Be sure to include the address of the retail site where the equipment or supplies were purchased, using the following fields:

Field 32 on the CMS-1500 claim
Loop 2310C (claim level) on the 837 professional electronic claim

Diabetic supplies are purchased from a DME supplier located in the Plan X service area and are shipped by that supplier to a member in the Plan Y service area.
File with: Plan Y

Diabetic supplies are purchased at a DME supplier’s retail store in the Plan X service area.
File with: Plan X

Diabetic supplies are purchased from a DME supplier in the Plan X service area and shipped or mailed to a member in the Plan X service area.
File with: Plan X

Independent clinical laboratory (place of service code 81)

Types of service include analysis of blood, urine, etc.

File the claim to the state where the referring physician resides

Referring provider:

Field 17B on the CMS-1500 claim
Loop 2310A on the 837 professional electronic claim

Note: Be sure to enter the national provider identifier of the referring physician in field 17B.

Referring physician resides in the Plan X service area. Blood analysis is done by an independent lab in the Plan Y service area.

File with: Plan X
Note: Claims for services performed by an independent lab must be filed with the plan in the state where the referring physician resides.