Service Location, Admitting Privileges and ZIP+4 Reminder
Issue: #392 JAN2017
For the past couple years, Blue Cross Blue Shield of North Dakota (BCBSND) has been striving toward enhanced provider assignment logic in claim processing. Required billing elements have been communicated within various HealthCare News (HCN) articles. This notification is a culmination of all prior communication related to the enhanced elements of the new logic. The system enhancement was implemented in December 2016.
Not meeting the requirements below will result in claims being deleted and returned. Deleted claims will require submission of a new claim.
- Professional claims submitted for service locations not on file for the professional provider’s NPI will be returned for correction and will need to be resubmitted as new claims after the new location has been added (see “Providers adding a location” below).
- Professional claims submitted for hospital admission services will be returned if the admitting physician is not on file for that service location.
- Professional claims submitted with a service location ZIP code that is missing the four-digit extension or does not match what was provided during the credentialing process will be returned for correction and will need to be resubmitted as new claims with the required ZIP+4 in the service location address field.