July 2017
Medicare Plus BlueSM PPO updating claim editing processes
Starting in October 2017, Blue Cross Blue Shield of Michigan’s Medicare Plus BlueSM PPO will enhance our claim editing processes to:
- Continue to promote correct coding.
- Continue to integrate applicable, appropriate local and national coverage determination guidelines in a way that will simplify our claims payment system.
These improvements will make our claims payment system easier for you and your billing staff to navigate. Medicare Plus Blue PPO will communicate unique clinical editing reason codes on the 835 response files or provider vouchers.
As a Medicare Advantage organization, Medicare Plus Blue PPO’s medical and payment policies comply with:
- National coverage determinations
- General coverage guidelines included in original Medicare manuals and instructions
- Written coverage decisions of the local Medicare administrative contractor
Reminder: When billing Medicare Plus Blue PPO, the guidelines and regulations established by these sources should be followed:
- Centers for Medicare & Medicaid Services’ medical policies
- American Medical Association CPT coding guidelines
- National bundling edits, including the Correct Coding Initiative
- Modifier usage
- Global surgery period
- Add-on code usage
As part of your contract with us, providers affiliated with Medicare Plus Blue PPO network agree to supply services to Blue Cross members and bill in accordance with these guidelines and requirements.
If you have questions about this update to Blue Cross’ Medicare claim editing process, contact our Provider Inquiry unit at 1-866-309-1719. |