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May 2017

Reminder: DME claims filing rules

According to Blue Cross and Blue Shield Association rules, durable medical equipment suppliers should file claims with the Blue plan in the state where the equipment or supplies were shipped (including mail-order supplies) or purchased (if purchased at a retail store).

Refer to the following guidelines when filing DME claims. Note: These guidelines apply to all members, including those with Medicare Advantage.

Types of service

Where to file

Fields to use when filing a claim

Examples showing which Blue plan to submit claims to

Types of service include
hospital beds, oxygen tanks, crutches, diabetic supplies, etc.
Note: Enter appropriate place of service code.

File the claim with the plan in whose state the equipment or supplies were shipped or purchased in a retail store.

Patient’s address:
Make sure to indicate the address of where the DME is shipped 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:
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 (e.g., Michigan) and are shipped by that supplier to a member in the Plan Y service area (e.g., Florida).
File with: Plan Y
(Florida)

Diabetic supplies are purchased at a DME supplier’s retail store in the Plan X (e.g., Michigan) service area.
File with: Plan X
(Michigan)

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

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2016 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
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