Outpatient Claims and ANSI Code CO97
Issue: #409 Jul2019
With the new Blue Cross Blue Shield of North Dakota (BCBSND) claims processing system, the use of the ANSI reject code CO97 has caused some confusion that BCBSND would like to clarify. CO97 advises that the payment has been adjusted because the procedure/service is not paid separately. For outpatient claims, BCBSND uses a surgical roll-up which means some services are packaged and thus not separately reimbursable. For more information on surgical roll-up, please refer to Issue 406 of HealthCare News or the BCBSND Provider Manual.