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DPAP 215

Claim Submission Criteria for Medical Claims on CMS 1500 Form


Provider Administrative Policy

Section
General Information
Policy Date
September 2013
Status/Date
Revised/July 2014
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Blue Cross of Idaho works diligently on behalf of our members to develop contracting relationships with Idaho dental providers and Blue Cross Blue Shield dental affiliates (national Dental Grid).

 


Policy

Claim Submission Criteria for Medical Claims on CMS 1500 Form

Blue Cross of Idaho does not accept claims submitted on a CMS 1500 Claim Form with a combination of CPT procedure codes and CDT codes. We will return claims received with a combination of codes for correct coding. Filing claims with a CPT procedure codes for consideration under a member's medical policy can be done using the CMS 1500 Form. This form requires the use of CPT procedure codes and ICD-9 diagnostic codes.

Claims billed with CDT codes on an ADA Dental Claim form for consideration under a member's medical policy must be submitted to the address on the member's insurance card. BlueCard claims processing guidelines will not allow claims billed with CDT codes to be processed through the local plan.

Claims billed on a CMS1500 claim form with CPT codes for consideration under a member's medical policy should be submitted to your local plan for BlueCard claims processing.

Please contact your provider relations representative with any questions (DPAP100)


Policy History

Date Action Reason
July 2014 Revised BlueCard language added