Reminder: Use Blue Cross editing process for FEP claims

In December 2018, Blue Cross Blue Shield of Michigan updated its professional and outpatient facility PPO claim editing process. Unique clinical editing reason codes were added to the 835 response files and provider vouchers.

When billing PPO claims for Federal Employee Program^® members, follow the same guidelines:

• The American Medical Association’s Current Procedural Terminology, or CTP, code set regarding:
• Correct modifier usage
• Evaluation and Management reporting guidelines
• National bundling edits
• National specialty societies, such as:
• American College of Surgeons
• American College of Radiology
• American Association of Neuromuscular and Electrodiagnostic Medicine
• American Cancer Society

As part of their contract with Blue Cross, health care providers affiliated with the PPO network agree to bill according to guidelines and requirements set by the AMA and select specialty societies.

If you have questions about FEP claim editing for professional and facility providers, call the FEP Customer Service line at 1-800-482-3600.