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Update: Ancillary Claims Filing - BCBSNC Requirements

Release Date: June 21, 2012

Revision Date: August 30, 2012

Please note:  This article has been revised from the original version.  Further contact information has been added, as well as updates were made to the impacted/non-impacted products.    

Effective October 14, 2012, Blue Cross and Blue Shield of North Carolina (BCBSNC) will make changes to our claims processing system, which will automate claim filing requirements for Ancillary Providers and some providers may see changes in where their claims are processed. 

Please see the claim filing guidelines for Ancillary Providers:

  • Services performed by an Independent Clinical Laboratory (Lab) should be filed to the Blue Plan in which State the specimen was drawn.
  • Durable/Home Medical Equipment and Supplies (DME) should be filed to the Blue Plan in which state the equipment was shipped to, or the location of the store if purchased at a retail location.
  • Specialty Pharmacy claims should be filed to the Blue Plan based on the location of the Ordering Physician.

Remote Provider Type

Where to File

Example

Remote Provider Contract with BCBSFL

Independent Clinical Laboratory (Lab)

The Plan in whose service area the specimen was drawn.

BCBSNC member has blood drawn in a lab or office setting located in Florida. 

File to:  BCBSFL

Yes – Claim is processed as participating.

No – Claim is processed as non-participating*.

Durable Medical Equipment (DME)

The Plan in whose service area the equipment was shipped to or purchased at a retail store.

BCBSNC member purchases DME.  DME is shipped from the provider to Florida address.   

File to:  BCBSFL

Yes – Claim is processed as participating. 

No – Claim is processed as non-participating*.

Specialty Pharmacy

The Plan in whose service area the ordering physician is located.

BCBSNC member receives medication ordered by a Florida provider. 

File to:  BCBSFL

Yes – Claim is processed as participating.

No – Claim is processed as non-participating.*

*Please note, when a non-participating claim for a BCBSNC member is processed, any payment for that claim, will be made to the member. 

  1. The ancillary claim filing rules apply regardless of the provider’s contracting status with the Blue Plan where the claim is filed.
  2. Providers are encouraged to verify Member Eligibility and Benefits electronically using Blue e.  If contacting by phone providers should call 1-800-676-BLUE or the number on the back of the Member ID card, prior to providing any ancillary service.
  3. Providers that utilize outside vendors to provide services (example: sending blood specimen for special analysis that cannot be done by the Lab where the specimen was drawn) should utilize in-network participating Ancillary Providers to reduce the possibly of additional member liability for covered benefits.  For a list of specialty pharmacies and participating DME providers, please utilize the Find a Doctor tool on the www.bcbsnc.com Web site.  Please note, participating providers may contact the Provider Blue LineSM at 1.800.214.4844 to verify participating laboratories.
  4. Members are financially liable for ancillary services not covered under their benefit plan.  It is the provider’s responsibility to request payment directly from the member for non-covered services. 

If you have any questions about where to file your claim, please contact the Provider Blue LineSM at 1.800.214.4844.

These ancillary claims filing requirements apply to all BCBSNC commercial lines of business, including the State Health Plan and our Medicare Advantage products - Blue Medicare HMO Blue Medicare PPO. This requirement does not apply to the Federal Employee Program (FEP) and Medicare Supplement products.