BlueCard^® connection: Why am I being contacted to provide referring provider information on my claim?

Blue plans may need to contact the referring provider if they require additional information to determine the medical necessity for services reported on your claim. If the referring provider name and national provider identifier aren’t included on your claim, we’ll contact you by phone. Providing the information during the call when it’s available to you will prevent delays in processing your claim.

Although the referring provider name and NPI aren’t required fields on a UB-04 claim form, providing the information when it’s available will assist in processing your claim. The information will also expedite requests for medical records that an out-of-area plan may require to determine the patient’s contracted benefits.

For more information on the BlueCard program, including links and articles on online tools, reference the BlueCard chapter of the online provider manuals.

If you’re experiencing issues with the information provided in the BlueCard chapter of the online manual — or if you’d like more information on a particular topic — contact your provider consultant.

Want to suggest a topic to be covered in this series? Send an email to ProvComm@bcbsm.com and put “BlueCard series” in the subject line.