IBC requires that professional claims be billed on one CMS-1500 claim form or electronic 837P transaction as it relates to two or more services performed for the same patient, by the same performing provider, and on the same date of service. The only exception would be when we specifically require services to be billed on separate claims based on an IBC policy (i.e., assistant or co-surgery claims).

Claims submitted otherwise are considered split-billed claims when there is no policy that requires billing on separate claims. More specifically, claims are considered split billed when more than one claim is submitted for payment for two or more services performed for the same patient, by the same performing provider, and on the same date of service and there is no policy to support split billing. Some examples of split billing include:

• two or more procedures and/or services performed by the same performing provider, on the same date of service, on the same patient, submitted on more than one claim form;
• services considered included in the primary services and procedures as part of the expected services for the codes billed on separate claim forms.

Providers must bill for all services performed on the same day for the same patient on a single claim form. Failure to do so prohibits the application of all necessary edits and/or adjudication logic when processing the claim. As a result, claims may be under or overpaid.

Based on recent routine reviews of paid claims data, IBC has identified numerous instances of split-billed claims. Please note that IBC will adjust and reprocess split-billed claims received prior to October 1, 2011, consistent with the terms of its provider agreements, including without limitation its Provider Manual for Participating Professional Providers and Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers.

For claims received on or after October 1, 2011, if more than one CMS-1500 claim form or electronic 837P transaction is received for services performed on the same patient, by the same performing provider, and on the same date of service as a previously submitted claim, and there is no policy to support split billing, we will adjust all individually submitted claims to deny. Providers will be required to submit the split-billed services as a single, new claim for payment consideration.

To the extent that service(s) for which there is no policy to support split billing is inadvertently omitted from a previously submitted claim, the previous claim should be corrected. To submit a corrected claim, please use the Claim INFO Adjustment Submission transaction on the NaviNet? web portal. Providers who are not NaviNet enabled should use the Provider Automated System by calling 1-800-ASK-BLUE. Please do not submit a separate claim for the omitted services, as that will create a split-billed claim and all individually submitted claims will be adjusted to deny.

If you have any questions regarding these billing procedures, please contact your Network Coordinator.