Medicare Plus Blue^SM PPO updating claim editing processes

Recently, we told you about how, starting in October, Blue Cross Blue Shield of Michigan’s Medicare Plus Blue^SM PPO will enhance our claim editing processes to:

• Continue to promote correct coding.
• Continue to integrate appropriate local and national coverage determination guidelines in a way that will simplify our claims payment system and make it easier for you to navigate.

Medicare Plus Blue PPO will include 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 the 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.