To correctly submit Institutional Health Care Claims to BCBSIL, the billing, pay-to provider, attending physician name, operating physician name, service facility name, and other provider name must be included in the correct loops.
Do not put the rendering provider NPI in the billing loop of the claim. Rendering information must go in the rendering loop and billing information must go in the billing loop.
Claims will be rejected if billed incorrectly. Field 17b: Enter the NPI of the referring, ordering, or supervising provider. Field 24j unshaded : Enter the NPI of the rendering provider. Field 32a: Enter the NPI number of the service facility location. Field 33a: Enter the NPI number of the billing provider. Your NPI is used for claims processing and internal reporting. Remember, claims processing cannot be guaranteed if you have not notified Blue Cross of your NPI, by using one of the methods above, prior to filing claims.
See the first part of this section for more details on how to submit claims to Blue Cross. If you have any questions about the NPI relating to your Blue Cross participation, please contact us at , option 3. Any special documentation in the medical record required? Messages 16 Best answers 0.
Messages 1, Location Selden Best answers 3. I definitely do not agree with the advice to use Q5 as that code has requirements that I feel do not fit your situation. Any practice I have ever worked at, as soon as a new clinician was being hired, even before employment start date, sent out insurance credentialing.
That would be my general recommendation. I unfortunately do not know how to solve your problem in the meantime, but I don't think Q5 is the answer.
To my knowledge you cannot bill the employee physician as an in network provider at this time. You would have to advise the patient's the Physician XYZ is not in network prior to service and it's best if they sign an acknowledge of notification of such. Once credentialing packets are gone out, you may be able to hold the claims depending on the plan's policies for credentialing and bill once you get notice of in network status, but that can take up to 90 days.
You would still bill employee physician as rendering. As of January , "Telecommunications Service Provider" is defined to mean any of the following:. Services means those functional services ancillary to the supply of the goods, such as transportation and any other incidental services, such as installation, commissioning, provision of technical assistance, training, catering, gardening, security, maintenance and other such obligations of the supplier covered under the contract.
Mental health services provider means an individual, licensed or unlicensed, who performs or purports to perform mental health services, including a:. Project Based IT Consulting Services An OGS Centralized Contract which will provide a set of standardized terms and conditions, guidelines, processes, and templates for the development, distribution and award of specific deliverable-based and fixed-price Information Technology projects.
Project Plan A formal, approved document used to guide both project execution and project control. The primary uses of the project plan are to document planning assumptions and decisions, facilitate communication among stakeholders, and document approved scope, cost, and schedule baselines.
Retainage A portion of the Authorized User and Contractor fixed-price agreement amount that is held back by the Authorized User until the deliverable or project is satisfactorily finished. Should Denotes the permissive in a contract clause or specification. Refers to items or information that the State has deemed are worthy of obtaining, but not required or obligatory.
Vendor An enterprise that sells goods or services. Health care services as defined by federal and state regulations. Dependent An individual who has insurance coverage under the policy of another individual.
Definitions The following definitions apply to terms used in the Professional Claim. An example includes, but is not limited to, supervision of a resident physician.
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