BlueCard is a national program offered through the Blue Cross and Blue
Shield Association (BCBSA), an association of independent Blue
Cross® and Blue Shield® plans, that enables
members of one Blue Plan to obtain health care benefits and services while
traveling or living in another Blue Plan?s service area. The BlueCard Program
links participating health care providers with the various Blue Cross and Blue
Shield plans across the United States and in approximately 170 countries and
territories worldwide through a single electronic network for claims processing
and reimbursement.
We want to remind you of the standardized claims filing guidelines for
providers of durable medical equipment (DME) that were implemented in 2012.
Note: These billing guidelines do not apply to claims submitted for
Federal Employee Program (FEP) members. These claims should continue to be
submitted based on FEP claims filing guidelines.
DME providers contracted with Independence
How to file (required
fields)
Where to file
Patient?s Address:
- Field 5 on CMS-1500, or
- Loop 2010CA on 837P
Ordering Physician:
- Field 17 on CMS-1500, or
- Loop 2420E (line level) on 837P
Place of Service:
- Field 24B on CMS-1500, or
- Loop 2300, CLM05-1 on 837P
Service Facility Location Information:
- Field 32 on CMS-1500, or
- Loop 2310 (claim level) on 837P
File the claim to the local Plan for the service
area where the DME supplies were shipped to or picked up from.
Example:
- For an Independence member, regardless of where DME supplies are shipped to
or picked up from, the DME supplier must bill directly to Independence.
- If a Blue Plan member is having DME supplies shipped to or picked up at a
location in the five-county Philadelphia region, the DME supplier must bill
directly to Independence.
- If a Blue Plan member is having DME supplies shipped to or picked up at a
location outside the five-county Philadelphia region, the DME supplier must
bill to the local Plan where the DME supplies were shipped to or picked
up.
DME providers who are not contracted with
Independence or any other Blue Plan
For Independence or any other Blue Plan member, the DME supplier must bill
the local Plan for the service area where the DME supplies were shipped to or
picked up from.
Note: Since the ancillary provider does not have a contract with
Independence or any other Blue Plan, the claim would be considered a
nonparticipating provider claim.
DME providers contracted with a Blue Plan
other than Independence
If you are contracted with a Blue Plan other than Independence,
always bill that Blue Plan for services rendered to that Plan?s enrollees. In
addition, you should bill services rendered to any other Blue Plan member in
your contracted Blue Plan?s service area to that Blue Plan. For example, for a
provider contracted with Horizon Blue Cross and Blue Shield (Horizon), bill
Horizon for DME supplies shipped to or picked up in New Jersey for any other
Blue Plan member.
If services are rendered to Blue Plan members who are not enrolled with your
contracted Blue Plan or for services rendered outside your contracted Blue
Plan's service area, you should bill the local Plan for the service area where
the DME supplies were shipped to or picked up from. These claims will be
considered nonparticipating claims.