As of April 19, 2015, claims from providers of emergency and non-emergency air ambulance services provided within the U.S., U.S. Virgin Islands, and Puerto Rico are to be filed with the local Plan in whose service area the point of pick-up occurred, per a new requirement from the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. This change applies to the following air ambulance service codes: A0430, A0431, A0435, A0436, S9960, S9961, and T2007.

Claims without a point of pick-up ZIP code, or claims with multiple ZIP codes, will be rejected.

Upon receiving the claim, the Host Plan must validate the point of pick-up ZIP code for air ambulance service on claims with dates of service on or after April 19, 2015. Validation is based on the following guidelines from the Centers for Medicare & Medicaid Services (CMS) for air ambulance claims:

• CMS-1500 (2/12) claim form or 837P. In item 23 of the CMS-1500 claim form, or the equivalent field of the 837 professional transaction (loop 2420G), billers shall code the five-digit ZIP code of the point of pick-up. If the ZIP code is not in the Plan's service area, the claim will be rejected.
• UB-04 claim form or 837I. When the UB-04 claim form is used for air ambulance service (excluding claims submitted with a facility's negotiated arrangement with an air ambulance provider), billers shall populate Form Locators 39-41 with Value Code "A0" and the five-digit ZIP code of the point of pick-up (corresponding 837I field: Loop 2300, HI01-1 = BE, HI01-2 = A0, HI01-5 = Pick-up ZIP code). The Form Locator must be populated with the approved code and value specified by the National Uniform Billing Committee in the UB-04 Data Specifications Manual.
• Format. The format for a ZIP code is five digits. If a nine-digit ZIP code is submitted, the last four digits will be ignored. If the data submitted in the required field does not match that form, the claim will be rejected.

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