Reminder: Billing guidelines for BlueCard® claims for DME providers

August 18, 2017

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.