Please also review the following billing policies for all providers: Reconsideration of a Claim (Appeals vs.Overlapping MHCP and managed care organization (MCO) coverage.This section outlines the following for all MHCP providers: Minnesota’s Uniform Electronic Transactions and Implementation Guide Standards (PDF) require all Minnesota-based health care claims to be submitted electronically. The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires all health care providers and payers to use universal standards for electronic billing and administrative transactions (health care claims, remittance advice, eligibility verification requests, referral authorizations and coordination of benefits). Contact the appropriate MCO to learn about the billing policies for services provided to MCO-enrolled MHCP members. MHCP members enrolled in a managed care organization (MCO) contracted with MHCP receive their health care services through the MCO. Minnesota Health Care Programs (MHCP) providers and their billing organizations must follow MHCP billing policies as outlined in this section and provider type specific sections of the MHCP Provider Manual for billing services provided to FFS members. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.In a fee-for-service (FFS) delivery system, providers (including billing organizations) bill for each service they provide and receive reimbursement for each covered service based on a predetermined rate. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. Availity provides administrative services to BCBSIL. Mental, Behavioral and Neurodevelopmental DisordersĪvaility is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals.Asthma and Asthma-Associated Conditions.We’ve put together some documentation and coding tip sheets for the following conditions: High quality documentation and complete, accurate coding can help capture our members’ health status and promote continuity of care. For complete details, refer to the BlueCard Program Manual.The three-character prefix preceding the member’s ID number is critical for proper routing of BlueCard claims.The program allows you to submit claims for members from other BCBS Plans to the Illinois Plan.To confirm receipt and adjudication progress, check claim status.īlueCard is a national program that enables members of one Blue Cross and Blue Shield (BCBS) Plan to obtain health care services while traveling or living in another BCBS Plan’s service area.Blue Cross Medicare Advantage, c/o Provider Services, P.O.Blue Cross Community MMAI (Medicare-Medicaid Plan), c/o Provider Services, P.O. Blue Cross Community Health Plans, c/o Provider Services, P.O.Mail original claims to the appropriate address as noted below. There are different addresses for Blue Cross Community Health Plans SM, Blue Cross Community MMAI (Medicare-Medicaid Plan) SM and Blue Cross Medicare Advantage SM claims. If necessary, government programs paper claims may be submitted. Box 805107, Chicago, IL 60680-4112.Įlectronic claim submission is preferred, as noted above. If necessary, commercial paper claims may be submitted as follows:
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