Which state governs billing?

suemt

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If the insured has BC of IL, and the provider is in FL, but the lab is in OH, which BC do you bill?
 

JEYCPC

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Frederick, MD
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I'm a coder and haven't done billing in a few years. Last I knew however, you would bill the local Blue to the provider.
 

jhartwig

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Martinez, CA
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Always bill the local

Bill the local BCBS plan. If the provider is located in FL, bill FL. FL will attach the contract rate if the provider is contracted. FL will then forward the claim to IL. IL will then use the contracted rate to apply the patients benefits.
I assume the lab in OH is a separate provider and therefore, on a separate. If so, then the lab services claim would go to the appropriate OH BCBS. They do the pricing and forward the claim to the home plan (IL) to apply the patient benefits.
 
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