BlueCard^® connection: How do I report an outpatient BlueCard claim for screening and diagnostic services on same claim?

BlueCard claims should be reported the same way you’re required to report services for any in-state commercial Blue Cross Blue Shield of Michigan claim. Claims reported for both screening or preventative and diagnostic services can be reported on a single claim or billed separately on two claims.

Splitting the preventative or screening services from the diagnostic services on two separate claims results in each category of service being processed separately, based on a member’s contracted benefits. It doesn’t result in a duplicate rejection. Splitting the claims also doesn’t require you to contact our Provider Inquiry department to request assistance in getting dual diagnosis services processed on a single claim.

If you choose to report all services with dual diagnoses on a single claim form, please keep the following in mind:

• Currently, the electronic 837 file doesn’t include diagnostic pointers that identify which diagnosis applies to each service reported on the claim. The claim will process based on the first diagnosis on the claim.
• You should report the screening or preventative diagnosis code first on a dual diagnosis claim.
• A replacement claim (frequency code 7) won’t reprocess the claim to reconsider the diagnostic services when the preventative services on the same claim were processed.
• When the preventative or screening services have been processed, you should contact Provider Inquiry to determine which services on the claim should be processed with the diagnostic ICD-10 codes. The Provider Inquiry representative will initiate an adjustment on your behalf.

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.

Have a BlueCard question you’d like answered?

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.