Reminder About Waivers
Release Date: July 27, 2012
Blue Cross and Blue Shield of North Carolina (BCBSNC) is reminding providers about the appropriate use of member waivers in their office. BCBSNC network providers can utilize a waiver of non-covered services when the member is properly informed, in advance, that BCBSNC does not cover a particular service and the member agrees in writing to be financially responsible for that specific service.
A waiver of non-covered services must be in writing and include the following information:
- Indication that the beneficiary is enrolled in BCBSNC coverage
- Reference to the specific non-covered service or procedure that is not covered. If an appropriate CPT code exists that covers several procedures rendered, the provider must use the all-inclusive procedure code and not bill for each procedure separately
- Notice that the service or procedure is not covered
- A written agreement that the member is to be financially responsible for non-covered services prior to the date of service
- Member's signature
- Date signed
This waiver may not be used for BCBSNC services that are not payable for other than benefit reasons (e.g., ClaimCheck edits, administrative expenses, difference between the allowed amount and paid amount).
Providers must maintain copies of the waiver in their office and fully inform members in advance when specific services or procedures are not covered. A general statement of financial liability does not satisfy this requirement. Generic waivers are not sufficient and providers cannot use waivers to circumvent timely filing rules or bundling edits.
If the member has signed a service-specific waiver and/or a payment plan agreement with the provider, then the member is responsible for the charges, regardless of the denial stating the provider has to write-off the charges. As necessary, BCBSNC will request from the provider a copy of the signed/dated service-specific proof of waiver.
If you have questions, please contact the Provider Blue LineSM at 1.800.214.4844.