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May 2015

BlueCard® connection: answer to a recent question

As part of our ongoing series on the Bluecard program, here’s the answer to a question we recently received.

Sometimes I’m asked to provide information on a BlueCard claim that I would normally not provide when billing claims to Blue Cross Blue Shield of Michigan for an in-state member. Am I required to provide that information to get the claim processed?

Blue plans may request more information or ask that you report information on a claim differently than you are required to report to Blue Cross Blue Shield of Michigan for our Commercial business. Although you are not required to report a claim differently than you would for a Michigan member, providing the information can assist in processing the claim. The Blue plan requesting the information may have a system limitation or require the additional information in order to determine the member’s contracted benefits.

If you have questions about a request you received for information on a pended or rejected BlueCard claim, please contact Provider Inquiry. Provider Inquiry can assist you in determining the needed information or contact the plan when necessary.

Effective April 19, 2015, you may be asked to provide additional information on a BlueCard claim for members enrolled in a Medicaid plan administered by another Blue plan. Medicaid claims processed through BlueCard are required to meet Medicaid reporting requirements. Failure to provide the information as requested by the member’s home plan can result in nonpayment of the claim. This policy is documented in the BlueCard chapter of the online provider manuals on web-DENIS under the topic “Medicaid Related Claims.”

If you’re experiencing issues with the information provided in the BlueCard chapter or any of the online tools — or if you’d like more information on a particular topic — contact your provider consultant. If you’d like to suggest a topic to be covered in a future issue of The Record, send an email to ProvComm@bcbsm.com and put “BlueCard series” in the subject line.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
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