Medicare Plus Blue claims submission process has changed for musculoskeletal procedures that originate in emergency department

For claims submitted on or after Oct. 1, 2021, you no longer need to call Provider Inquiry for musculoskeletal surgical and related procedures originating in the emergency department for Medicare Plus Blue℠ members. Instead, you’ll simply submit the claim with an emergency indicator of Y on the CMS-1500 claim form or the SV109 field of the 837P claim transaction.

For Blue Cross Blue Shield of Michigan and Blue Care Network commercial and BCN Advantage℠ members, continue to follow your usual process for submitting these claims.

As a reminder, you don’t need to request prior authorization from TurningPoint Healthcare Solutions LLC for orthopedic, pain management and spinal procedures when they’re performed emergently during an inpatient admission that originated in the emergency department.

To learn more about claims for musculoskeletal procedures, see the “Claims” section of the document titled Musculoskeletal procedure authorizations: Frequently asked questions for providers.