Itemized Bills Required for BlueCard® Facility Claims Over $100k

Sep. 30, 2020

Beginning Jan. 1, 2021, we will require facilities to submit an itemized bill for inpatient care billed for $100,000 or more. This applies to all facility claims for $100,000 or more submitted for BlueCard out-of-area Blue Cross and Blue Shield members. An itemized bill helps ensure an accurate claim payment and reduces the need to submit more information after a claim is paid.

What’s Changing

The BlueCard claim amount requiring itemization will be lowered to $100,000 from the current $200,000 threshold.

How to Submit Itemized Bills

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You may submit itemized bills electronically using our Claim Inquiry Resolution tool. Include the corresponding claim number for quicker review and turnaround time.

More Information

Refer to our Inpatient/Outpatient Unbundling Coding and Compensation Policy PDF Document on our provider website for more information. 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.