Issue: #389 JUL2016
All medical record documentation must comply with Blue Cross Blue Shield of North Dakota (BCBSND) policies and support the services and diagnosis submitted on the claim form at the time of the original claim submission to BCBSND.
If medical chart documentation has been submitted to BCBSND for review and the documentation was found to not meet BCBSND policy or the CPT®, ICD-10, or HCPCS codes submitted on the original claim, or it does not meet the requirements requested as part of a claim adjustment, notification will occur. It would be considered inappropriate to then modify the documentation in an attempt to meet the documentation requirements for the submitted codes or documentation requirements. Documentation modified in this manner will not be considered for claim payment.
It is also considered inappropriate to utilize the Billed in Error option of the claim adjustment form to attempt to circumvent the review process of other adjustment types or to attempt to have a claim paid that has been previously determined to not be payable as requested after review. Billed in Error is used when services were not performed, the wrong patient/member was billed, or charges are being removed from the patient account. Any other use would be considered inappropriate.