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Wiki Blue Cross Blue Shield out of state coding policies

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hmorrison1981@gmail.com

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I am in Massachusetts, so claims go to BCBS MA. But some are for out of state plans, e.g. BC of Idaho. How can I find out what plans want the X-rays split to TC/26 components? BCBSMA says I have to ask the respective plan, but they wouldn't tell me the policy. I'd rather not set up an account for each state. I tried RETTE AI; didn't have the information.
 
It depends on your contract with BCBS but at my facility the home plan (BCBS MA in your case) is responsible for that, we code based on the home plans policies and they are responsible to accurately report that back to the local plan. We have a lot of issues with this.
 
You can find that on the specific plan's website/portal (does not always require a portal account). The policies from the patient's plan are responsible for determining necessity and coverage.
 
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