Feb. 7, 2025
Beginning April 7, 2025, we may require you to submit an itemized bill for some additional commercial member claims at lower dollar thresholds to ensure consistency in processing. This applies to all non-Diagnosis Related Group facility claims with billed amounts at or above $75,000 submitted for commercial members of Blue Cross and Blue Shield plans. An itemized bill helps ensure an accurate claim payment.
Also beginning April 7, 2025, we will expand our review of select inpatient, DRG claims. The review will check for medical appropriateness and compliance with ICD-10 procedure and diagnosis coding system guidelines. For these claims, we may ask you to submit medical records for the claim to be processed.
How to submit itemized bills: You may submit itemized bills or medical records electronically using our Claim Inquiry Resolution tool. Include the corresponding claim number for quicker review and turnaround time.
Always check eligibility and benefits first through Availity® Essentials or your preferred vendor, prior to rendering services.
For more information: Refer to our Inpatient/Outpatient Unbundling Coding and Compensation Policy in Availity Essentials. If you have questions, contact your Network Representative.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding any products or services provided by third party vendors.