Bluecard® Alert: Itemized Bill May be Required For Some Inpatient Claims, Effective January 1,2020
Beginning January 1, 2020, BCBSMT will lower the itemized claim review threshold for out-of-area member claims to $200,000 and up. Additionally, audits may occur for claims below this dollar threshold as needed.
An itemized bill is needed for completion of a required pre-payment review process, as mandated by the Blue Cross and Blue Shield Association. The purpose of the review is to support accurate claim payment. The review also may help reduce the need for further inquiry or review once claims are sent to their home state for finalization.
If you receive a request for an itemized bill, you may submit it electronically, along with the appropriate claim number, using our Claim Inquiry Resolution tool.
For additional information on submitting claims for out-of-area Blue Cross and Blue Shield members, refer to the BlueCard Program Provider Manual. If you have questions, contact your BCBSMT Provider Network Consultant.