HealthCare News

Priority Diagnosis that will drive Severity of Illness (SOI)

Issue: #411 NOV2019

Topic: Reimbursement


The migrated Blue Cross Blue Shield of North Dakota (BCBSND) processing system requires providers to list any diagnosis code(s) necessary to drive the SOI on a DRG claim to be listed within the first 25 diagnosis code fields on the UB-04 Claim Form. Diagnosis codes needed for correct DRG SOI not included in the first 25 diagnosis fields will result in the claim processing at a lesser DRG SOI.