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Billing ambulance services for Medicare Advantage PPO members
Ancillary
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Effective October 14, 2012, ambulance providers are required to include ZIP
code information when billing ambulance services for Medicare Advantage PPO
(MAPPO) members.
Please use the following guidelines based on how you submit claims for
ambulance services:
Electronic claims. If you bill electronically via HIPAA 5010, please include
both the pick-up and drop-off ZIP codes in the appropriate fields.
Paper claims. If you bill claims on paper, please include the pick-up ZIP code
in box 23 of the CMS-1500 form. The ZIP code is the only data element that
should be included in that field.
You can identify MAPPO members by asking for their member ID card, which
contains "MA" in the suitcase logo. MAPPO members have been instructed to
provide their MAPPO ID card — not their Medicare ID card — when
presenting to you for services.
The MAPPO program is a national initiative of the Blue Cross and Blue Shield
Association, an association of independent Blue Cross® and Blue
Shield® plans, that enables enrollees in one Blue Cross and/or
Blue Shield MAPPO plan to obtain health care benefits and services from
participating Blue Cross and/or Blue Shield Plan providers while traveling or
living in another Blue plan?s service area.
Please contact your Network Coordinator if you have any questions about this
new requirement.