Update for 2016: Effective January 1, 2016, CPT code 83037 (Hemoglobin A1c Home Device) will also require a line item with the result using a CPT II procedure code.
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BCBS of AL will begin implementing Blue Advantage claim filing requirements for chronic conditions to obtain complete and accurate medical data. BCBS will begin rejecting claims without this data October 1st , 2014. Please view – https://www.bcbsal.org/providers/publications/providerFacts/2014-035.pdf
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BCBS Blue Advantage – To improve complete and accurate medical data for patients, Blue Cross and Blue Shield of Alabama (BCBS) will be implementing new Blue Advantage claim filing requirements beginning August 1st, 2014.The effective dates of the new claim filing requirements are based upon the claim submission date and not the date of service. Claims not meeting these claim filling requirements will be rejected. MediSYS provides tools for providers to use when documenting an encounter that will submit the new required codes. For those not yet using MediSYS’ electronic health records, submission of the appropriate procedure and diagnosis codes can be processed during charge entry.
Claim Filling Requirements:
• Body Mass Index (BMI) Claim Requirement – Effective August 1, 2014
- BMI diagnosis code will be required on each claim
- If BMI is not obtained, use one of the following HCPCS codes: G8421 – Not Documented/No Reason Given or G8422 – Not Documented/Patient Not Eligible for BMI Calculation
- ASC X12 Health Care Claim Acknowledgement (277HCCA) – Rejection code used if claim does not contain required information
• Blood Pressure (BP) Claim Requirement – Effective August 1, 2014
- 2 line items will be required: BP systolic procedure code on one line item and the BP diastolic procedure code on the other line item
- If BP is not taken, use HCPCS code G8478 (Blood pressure measurement not performed or documented, reason not given)
- ASC X12 Health Care Claim Acknowledgement (277HCCA) – Rejection code used if claim does not contain required information
• Diabetes Hemoglobin A1c (HbA1c) Lab Result Claim Requirement – Effective August 1, 2014
- Claims submitted using CPT code 83036 (Hemoglobin A1c) must include an additional line item with the result of the Hemoglobin A1c using a CPT II procedure code.
- ASC X12 Health Care Claim Acknowledgement (277HCCA) – Rejection code used if claim does not contain required information
• Chronic Conditions (Diabetes and COPD*) Claim Requirement – Effective October 1, 2014
Information obtained from the BCBS Provider Facts June 2014. You can view this document here: https://www.bcbsal.org/providers/publications/providerFacts/2014-027.pdf
MediSYS has tools for providers to comply with these new filing requirements. For details contact us.