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Billing Guidelines Introduction

This section of the Manual contains billing guidelines for various provider types. It was developed with consideration of the latest coding methodologies from several sources, including but not limited to:

  • Coding descriptions and instructions as identified in the latest release of the AMA CPT;
  • HCPCS developed by CMS, 19th edition (IPG);
  • Applicable laws in the state of Florida.

Some of the information contained in the Manual may not apply to you if your services are being accessed by BCBSF and its members through a management company or vendor arrangement (e.g. – New Directions Behavioral Health or CareCentrix).  Refer to your management company or vendor policies and procedures. 

Billing Requirements for Ancillary Providers 

In compliance with the HIPAA NPI mandate, BCBSF requires that only NPIs are to be submitted on all HIPAA electronic transactions, including claims. Providers may continue to submit BCBSF provider numbers and/or NPIs on the paper claim form, which is the CMS-1500 for ancillary providers. 
For ancillary providers who have a BCBSF and/or HOI provider agreement that does not require the registration of employed health care providers should only populate the billing provider information on the claim.  If the BCBSF and/or HOI provider agreement requires registration of employed health care providers, then the rendering and billing provider information should be billed appropriately on the claim.
 
The following is a sample of necessary provider billing information required on the CMS-1500 or electronic version 837
 
  • Ancillary Provider with registered employed health care providers
    • Rendering provider NPI in 24J (Loop 2310B & 2420A)
    • Billing provider NPI in 33 (Loop 2010AA)

  • Ancillary Provider with no registered employed health care providers
    • Rendering provider NPI – BLANK
    • Billing provider NPI in 33 (Loop 2010AA)
 

 

5/12/2014
The Manual is not intended to be a complete statement of all BCBSF polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and BCBSF or Health Options the terms of such agreement(s) shall govern.

The Manual is not intended to be a complete statement of all Florida Blue polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and Florida Blue or Health Options the terms of such agreement(s) shall govern.

Refer to the References section to view all applicable copyrights, registered trademarks, service marks, and/or references. Acronyms are also defined in the References section.

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