iLinkBlue 1500 Claims Entry Manual Claims Entry Manual.pdf · FACETS Edit Descriptions ... (NASCO)...

Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service & Indemnity Company.

17ED0015 R02/17

iLinkBlue 1500 Claims Entry Manual

iLinkBlue 1500 Claims Entry Manual February 2017 1

Blue Cross and Blue Shield of Louisiana’s

iLinkBlue 1500 Claims Entry Manual

This guide is designed to give detailed instructions on how to enter 1500 claims directly through iLinkBlue.

iLinkBlue allows the electronic submission of professional 1500 claim forms. This process allows providers the capability of submitting HCFA 1500 claims directly into the claims processing systems at Blue Cross and Blue Shield of Louisiana for Blue Cross, HMO Louisiana, Inc., Blue Connect and Community Blue members, as well as Federal Employee Program (FEP), BlueCard® (out-of-area) and National Account members.

To use your manual, first familiarize yourself with the table of contents, which will direct you to the information you need.

This guide is available on iLinkBlue (www.bcbsla.com/ilinkblue) under the “Resources” section.

If you have questions about the information in this guide, you may send an email to [email protected].

Please Note:

This guide contains general instructions. It is provided for informational purposes only. Every effort has been made to print accurate, current information. Errors or omissions, if any, are inadvertent.

CPT® only copyright 2017 American Medical Association. All rights reserved.


Table of Contents

Accessing the 1500 Claim Entry Form .................................................................................................................... 5

Professional Exceptions to Entry ............................................................................................................................... 6

The Contract Prefix Validation Application ........................................................................................................... 7

Special Instructions on Claim Completion ............................................................................................................ 7

ICD-9 and ICD-10 Claims Filing Guidelines .......................................................................................................... 9

Anesthesia Billing Requirements/Instructions ................................................................................................... 10

BCBSLA Professional 1500 Claim Entry Instructions ........................................................................................ 12

Ambulance Claims ........................................................................................................................................................ 25

BCBSLA Professional Claim Entry Confirmation ................................................................................................ 26

State Abbreviations ...................................................................................................................................................... 26

BCBSLA 1500 Professional Error Codes (Edits) .................................................................................................. 27

National Provider Identifier Edits............................................................................................................................ 32

BCBSLA Screen Pop Edits .......................................................................................................................................... 34

Place of Service File...................................................................................................................................................... 37

FACETS Edit Descriptions ........................................................................................................................................... 38

Professional Claims Entry Manual Revision History ......................................................................................... 40


Accessing the 1500 Claim Entry Form

The following instruction describes steps required to access the Blue Cross and Blue Shield of Louisiana 1500 claim entry form.

After logging into iLinkBlue, from the home page, click on “Claims,” then click on “Blue Cross Professional Claims Entry (1500)” under the Claims Entry & Reports section.


Professional Exceptions to Entry

If one of the following conditions exists, a claim cannot be entered through iLinkBlue. The claim must be submitted hardcopy (paper claim-manually) to Blue Cross and Blue Shield of Louisiana (BCBSLA).

Claims for physicians who have not been approved for electronic claims submission through iLinkBlue at your location.

Claims for Medicare Part B or Medicaid (Title XIX) physician services.

Claims with a line item charge or the total charge is equal to or greater than $99,000.00. Charge fields will only accept up to six digits.

Claims for members with BCBSLA supplemental contracts and Blue Cross members covered by Medicare Part B.

Note: Most supplemental claims will automatically cross over from the Part B carriers. BCBSLA claims that have been processed by Arkansas BCBS and did not cross over, can be entered on the 1500 Crossover screen. See the 1500 Crossover Supplemental User’s guide for assistance with entering these claims.

Claims for psychiatric/psychological service rendered by non-physicians, these charges must be submitted on the UB-04 form.

Claims for BCBSLA members who are also a covered member under an ambulance/emergency medical service (BCBSLA has no liability).

Claims for dentistry, durable medical equipment and nursing services.

BlueCard (out-of-area) or National Accounts (NASCO) claims BCBSLA does not process. Users can verify which contracts can be processed through BCBSLA using the Contract Prefix Validation application.


The Contract Prefix Validation Application

The Blue Cross Professional Entry screen accepts the following contracts:

1. Blue Cross and Blue Shield of Louisiana contracts (i.e. XU prefixes)

2. Federal Employee Program (FEP) contracts can easily be identified and can be filed through iLinkBlue. The contract number will begin with an ‘R’ in the first position followed by eight numeric characters. You are not required to add a ‘0’ (zero) at the end of the contract number to enter a claim. However, the ‘0’ is required if you are researching the Pended or Paid/Rejected screens or entering an Action Request.

3. BlueCard (Out-of-Area) Contracts

The BlueCard program allows providers to bill claims directly to BCBSLA for patients who are insured by an out of state Blue Cross Plan. For electronically submitted claims, the member’s ID number must include the three-digit alpha prefix and identification number, as indicated on the member ID card.

Note: Some prefixes are exempt from the BlueCard program and cannot be filed using the Blue Cross Professional Entry screen.

Special Instructions on Claim Completion

Listed below are guidelines and billing requirements to be followed when submitting 1500 claims to BCBSLA.

1. Regarding line items:

Do not combine charges (and enter as one line item) for services that have different CPT procedure codes, even if rendered on the same date by the same physician

Do not combine charges (or enter as one line item) for services rendered on different dates, unless the CPT code is the same

Do not combine the charges rendered by different physicians on one line

Do not combine the charges for Daily Pain Management. These charges must be submitted separately (by day) even though the CPT code is the same (see specific instruction for anesthesia)

If charges for ‘like’ services are combined and entered as one line item, the number of procedures or visits must be indicated in the TIMES field

If the fields are the same, you may use an * in any field of the line item to duplicate any field from the previous line


2. Charges for items such as prep trays, suture kits, bandages, catheter trays, pharmaceuticals, solutions, instrument usage, room usage, etc. should be combined with the physician’s fee associated with those services and billed as one charge under the CPT procedure for the professional service rendered.

3. If additional line items are needed to complete a claim (more than 10 line items), enter a total for the current line items. Click “Yes” in the MORE LINE ITEMS field; the patient information on the original screen will carry over to the next screen with the exception of PAY PROVIDER, ASSIGNMENT and PATIENT ACCOUNT # fields.

4. Never enter a corrected claim or a duplicate claim through iLinkBlue unless instructed to do so by a BCBSLA representative.


ICD-9 and ICD-10 Claims Filing Guidelines

Claims for dates of service on and after October 1, 2015, must be submitted with ICD-10 codes.

Claims for dates of service before October 1, 2015, must be submitted with ICD-9 codes. We do not accept claims that contain both ICD-9 and ICD-10 codes. See details below for professional and anesthesia claims filing rules.

Professional Claim Filing Rules

Scenario Claim Coding Requirements Claims Processing Rules Date of service is before October 1, 2015

Report ICD-9 codes If the claim is filed with ICD-10 codes, it will be rejected and must be resubmitted using ICD-9 codes

Date of service spans October 1, 2015

Claim should be split as follows: 1. Services provided before

October 1, 2015, should be coded on the first claim with ICD-9 codes

2. Services provided on or after October 1, 2015, should be coded on a second claim with ICD-10 codes

If the claim contains dates of service spanning the ICD-10 implementation date, it will be rejected

The rejected claims will need to be resubmitted with the appropriate version of ICD codes based on the date of service

Date of service is on or after October 1, 2015

The claim should be coded with ICD-10 codes

If the claim is filed with ICD-9 codes, it will be rejected and must be resubmitted using ICD-10 codes

Anesthesia Claim Filing Rules

Scenario Claim Coding Requirements Claims Processing Rules Dates of service before October 1, 2015 (procedure began and ended before October 1, 2015)

Report ICD-9 codes If the claim is filed with ICD-10 codes, it will be rejected and must be resubmitted using ICD-9 codes

Dates of service spans October 1, 2015 (procedure began September 30 and ended October 1, 2015)

File as a single claim with ICD-9 codes. The “Service From” and “Service To” dates of service should be filed as September 30, 2015, even if the procedure actually ended on October 1, 2015.

The claim will be rejected if the dates of service span October 1, 2015, or if the claim contains ICD-10 codes. The claim must be resubmitted with the appropriate date of service and ICD-9 codes.

Dates of service on or after October 1, 2015 (procedure begins and ends October 1, 2015, or after)

Report ICD-10 codes If the claim is filed with ICD-9 codes, it will be rejected by BCSBLA and must be resubmitted using ICD-10 codes.


Anesthesia Billing Requirements/Instructions

Listed below are claims filing requirements for all anesthesia claims. For specific questions, contact your EDI representative at (225) 297-2658.

1. For anesthesia claim submission, the surgery CPT procedure code is required for anesthesia with the following exceptions:

00857 01996

2. Indicate the minutes anesthesia was administered in the ‘TIMES’ field.

3. If anesthesia is administered for multiple procedures during the same operative session, place the total minutes in the “Times” field for the primary procedure. The secondary procedure should have 001 in the “Times” field.

4. The modifier field cannot be blank.

5. If applicable, use the PHYSICAL STATUS modifiers in the modifier field.

23 – Unusual anesthesia 47 – Anesthesia by surgeon P1 – A normal healthy patient P2 – A patient with mild systemic disease P3 – A patient with severe systemic disease P4 – A patient with severe systemic disease that is a constant threat to life P5 – A moribund patient who is not expected to survive without the operation P6 – A declared brain dead patient whose organs are being removed for donor

purposes

6. If a PHYSICAL STATUS modifier does not apply, you must use one of the following Level II (HCPCS/National Modifiers).

AA – Anesthesia services performed personally by anesthesiologist

AB – Medical direction (own employees) by anesthesiologist – less than 4 employees

AC – Medical direction (other than own employees) by anesthesiologist - Less than 4 employees

AD – Medical supervision by physician: more than four concurrent anesthesia procedures

AE – Direction of residents in furnishing not more than 2 concurrent anesthesia services, attending physician relationship met Registered dietitian

GC – This service has been performed in part by a resident under the direction without the presence of a teaching physician under the primary care exception

G8 – Monitored anesthesia care (MAC) for deep complex, complicated or markedly invasive surgical procedure


G9 – Monitored anesthesia care for patient who has history of severe cardiopulmonary condition

QK – Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals

QX – CRNA service: with medical direction by a physician

QY – Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist Anesthesiologist medically directs 1 CRNA

QZ – CRNA service: without medical direction by a physician

7. If the Blue Cross Contract Number Prefix is 'XUM' or Group Number is “C0019,” use the HCPCS/NATIONAL MODIFIERS ONLY for anesthesia billing.

8. “Qualifying Circumstances” and specialized forms of monitoring should be submitted on a separate line with the appropriate CPT code and charge. Qualifying circumstances or specialized forms of monitoring include services for the following:

Extreme age, under one year or over 70 years Anesthesia complicated by utilization of total body hyperthermia Anesthesia complicated by utilization of controlled hypotension Anesthesia complicated by emergency condition (defined as existing when delay in

treatment would lead to significant increase in the threat to life or body part) Arterial line CVP line Swan Ganz Pulmonary artery line

9. For EPIDURAL and PAIN MANAGEMENT, the following CPT codes should be used when billing for epidural or pain management:

00857 – The actual minutes must be entered in the “TIMES” field

01996 – Each date of service must be entered on a separate line with 001 in the “TIMES” field

01997 – Each date of service must be entered on a separate line with 001 in the “TIMES” field


BCBSLA Professional 1500 Claim Entry Instructions

The 1500 Form claim entry screen follows the format of the HCFA 1500 form R (12-90). The fields required for BCBSLA entry will be highlighted; all fields not required will be gray shadowed.

Follow the instructions below to complete the Blue Cross 1500 screen:

Form Numbers 1 through 8:

1a Insured’s ID# – Enter the patient/subscriber’s contract number as it appears on the BLUE

CROSS ID card. This will include the three position alpha prefix, if present. All Federal Employee Program contracts will have an “R” in the first position. If less than the entire field is used in any field, press the “Tab” key to move to next field.

2 Patient’s Name (Last, First, MI) – Enter the patient’s last name as it appears on the member ID card. Do not use spaces, punctuation or titles. If the patient is a stepchild or grandchild, enter last name even if it differs from the name on the ID card.

Enter the patient’s first name. Do not use nicknames. When filing for newborns, the infant’s given name must be used.

Enter the patient’s middle initial if available.

3 Patient’s Birthdate – Enter the patient’s date of birth in MMDDCCYY format. If the patient was born on March 18, 1992, enter 03181992. The birth date must be prior to or equal to the first date of service for the charges being submitted.

Sex – Select the patient’s sex as either “M” or “F.”


4 Insured’s Name (Last, First) – This field is only used for insured information on Federal Employee Program (FEP) contracts, BlueCard (out-of-area) or National Accounts. Enter the last name of the policyholder as shown on the Blue Cross ID card. Do not use spaces, punctuation or titles. Not required for Blue Cross and Blue Shield of Louisiana cardholders.

6 Patient Relationship to Insured – Indicate the relationship of the patient to the subscriber or cardholder. Must be one of the following:

Self (patient is the subscriber) Spouse (patient is married to the subscriber) Child (child dependent under age 19, includes stepchild) Other

7 Insured’s Address – The address fields (No., Street, City, State and ZIP Code) must be completed on all claims. Enter the route and box number, the P.O. Box number or the house number and street address. Enter the name of the city in which the subscriber/patient resides, the 2 position state abbreviation and the ZIP code.

Form Numbers 9 thru 11:

9 Other Insured’s Name – If block 11d indicates “Y” (Yes there is another health benefit plan)

and the other insured’s relationship (block 9) is Spouse, Child or Other, then the name and policy group number must be submitted.

If the relationship is “Self” (block 9), then no additional information is required.


9a Other Policy/Group # – Enter the policy number of the other coverage if applicable. Leave blank if there is no other coverage.

Group? – If block 11D is “Y,” indicate “Y” if a group or “N” if a non-group policy. If block 11D is “N,” then leave blank.

9d Insurance Plan or Program Name – Enter the name of the other insurance if the patient has other coverage. Leave blank if block 11D is “N.”

10 Is patient’s condition related to: – This section is regarding workmen’s compensation, auto accident and other accident involvement.

10a Employment? (Current or Previous) – When the claim being submitted is due to an employment-related condition, indicate “Yes.” If the claim is not due to an employment-related condition, indicate “No.”

10b Auto Accident? – If claim is related to an auto accident, indicate “‘Yes” and enter the two-position alpha state code indicating the state where the accident occurred. (e.g. LA, TX, MS, etc.)

10c Other Accident? – If claim is related to an accident that is not employment or auto, indicate “Yes.”

10d Claim Codes (Designated by NUCC) – Claim codes identify additional information about the patient’s condition or the claim.

The following is the list of condition codes for abortion that are valid for use on the 1500 claim form:

AA Abortion Performed due to Rape AB Abortion Performed due to Incest AC Abortion Performed due to Serious Fetal Genetic Defect, Deformity, or

Abnormality AD Abortion Performed due to a Life Endangering Physical Condition Caused

by, Arising from or Exacerbated by the Pregnancy Itself AE Abortion Performed due to Physical Health of Mother that is not Life

Endangering AF Abortion Performed due to Emotional/psychological Health of the Mother AG Abortion Performed due to Social or Economic Reasons AH Elective Abortion AI Sterilization

The following is the list of condition codes for worker's compensation claims that are valid for use on the 1500 claim form.

W2 Duplicate of original bill W3 Level 1 appeal W4 Level 2 appeal W5 Level 3 appeal


11 Insured’s Policy Group or FECA # – This field is only used for insured information on National Accounts and BlueCard (out-of-area) contracts. (This field can be blank on BCBSLA, FEP and National Account contracts if you have a valid three-position alpha prefix).

11d Is there another health benefit plan? – If the patient has other health insurance coverage, enter “Y” (yes) or “N” (no). If block 9a (other policy #) was left blank, the system will automatically skip 9a and 9d. The “N” will propagate for you and the cursor will go to block 12.

Form Numbers 12 through 23:

12 Patient’s or Authorized Person’s Signature – Indicate “Y” for patient’s signature or “I” for informed consent if the patient’s signature is on file for the release of medical records.

13 Insured’s or Authorized Person’s Signature – Indicate where payment is to be directed.

“A” for payment assigned to provider

“N” for payment assigned to subscriber

14 Date of Current Illness, Injury or Pregnancy (LMP) – If claim is auto accident related, report date of accident, onset of illness or last menstrual period (LMP). Enter date in MMDDYYYY format.


17 Name of Referring Physician or Other Source – Indicate the referring physician name, if a prior authorization number is reported in block 23. If the patient was not referred, skip these fields.

17b NPI# of Referring Physician – Indicate the National Provider Identifier (NPI) if a prior authorization number is reported in block 23. If the patient was not referred, skip these fields.

18 Hospitalization Dates – If the place of treatment for the services performed is 21, 31, 51, 55, 56 or 61, then a hospitalization admit date must be present in block 18. A discharge date can be submitted if known. For all other places of treatment leave blank.

19a Adjustment/Void Indicator – Required only if you are filing a corrected or voided claim. When present, must be one of the following:

“A” to Adjust original claim for: Corrections to dates of service Corrections to patient information Corrections to CPT or HCPCS codes Corrections to amounts Charged

“V” to void the entire original claim

19b Internal Control Number (ICN#) – This field is required if filing for an adjusted or voided claim. The original ICN# will identify the charge to be adjusted or voided. Must be the ICN# assigned to the original claim on the Remittance Advice. The ICN is the claim number from the BCBSLA Remittance Advice (Weekly Provider Payment Register).

21 Diagnosis or Nature of Illness or Injury – Enter the ICD codes that describe the services rendered. At least one diagnosis code is required on the claim for all services to be considered for payment. Up to 12 diagnosis codes can be entered.

Diagnosis A – In block A, please indicate the primary diagnosis code.

Diagnoses B-L – In blocks B-L, identify and report additional diagnosis codes in priority order if applicable. For each line of the claim, identify the appropriate diagnosis code(s) for that service by using the Diagnosis Pointer located on each line item to point to a maximum of four codes entered in the Diagnosis Code fields.

ICD Indicator (required field) – Select “9” from the drop down list when submitting claims with ICD-9 diagnosis codes. Select “0” when submitting claims with ICD-10 diagnosis codes.

Note: Do not include a decimal when entering diagnosis codes.

23 Prior Authorization # or ZIP Code – Enter the referral number when a contract or procedure has received an outside referral. An authorization date must be present if an authorization number is entered.

Note: If an outside referral was not obtained, zeros may be used in this field if the claim receives the edit “REFNO01.”


Form Number 24 A-K:

24A Service Date (from-to) – Enter the first and last dates of service for the charges being billed.

The “From” date must be prior to or the same as the “To” date. Each service date must be a valid date on or before the entry date. Use the MMDDYYY format.

Note: Dates cannot overlap calendar months, except when the place of treatment is 21 (inpatient). Dates on all line items must be in the same calendar year. The cursor will automatically move to the next field.


24B PLC (place of service) – Enter the appropriate place of service code. Entry must be one of the following:

01 – Pharmacy 03 – School 04 – Homeless Shelter 05 – Indian Health Service Free-

Standing Facility 06 – Indian Health Service Provider

based Facility 07 – Tribal 638 Free-Standing Facility 08 – Tribal 638 Provider based Facility 09 – Prison-Correctional Facility 10 – Prison-Correctional Facility 11 – Doctor’s office or clinic 12 – Patient’s home 13 – Assisted Living Facility 14 – Group Home 15 – Mobile Unit 16 – Temporary Lodging 17 – Walk-in Retail Health Clinic 20 – Urgent Care Facility 21 – Inpatient hospital 22 – Outpatient hospital 23 – Emergency room hospital 24 – Ambulatory surgical center 25 – Birthing center 26 – Military treatment facility

31 – Skilled nursing facility 32 – Nursing facility 33 – Custodial care facility 34 – Hospice 41 – Ambulance land 42 – Ambulance air or water 50 – Federally Qualified Health Center 51 – Inpatient psychiatric facility 52 – Psychiatric facility - partial

hospitalization 53 – Community mental health center 54 – Intermediate care/mentally retarded 55 – Residential substance abuse facility 56 – Psychiatric residential treatment

facility 60 – Mass Immunization Center 61 – Comprehensive inpatient rehab

facility 62 – Comprehensive outpatient rehab

facility 65 – End stage renal disease rehab facility 71 – State or local public health clinic 72 – Rural health clinic 81 – Independent lab 99 – Other unlisted facility

Note: a list of place of service codes is available by clicking on the link in the place of service field.

24C EMG (emergency related: Y or N) – This field is inactive as the emergency room indicator is not required on BCBSLA claims.


24D CPT4 – Enter the code that best describes the service rendered or procedure performed utilizing the most current edition of the Physicians’ Current Procedural Terminology. This field cannot be blank. When billing for anesthesia, the CPT must reflect the SURGERY procedure, not the anesthesia procedure code.

MODS – Procedure code modifier. If billing for anesthesia, the following physical status modifiers must be indicated. {some of the HCPCS modifiers listed on page 8-9 are missing below}

23 – Unusual anesthesia 47 - ??? P1 – A normal healthy patient P2 – A patient with mild systemic disease P3 – A patient with severe systemic disease P4 – A patient with severe systemic disease that is a constant threat to life P5 – A moribund patient who is not expected to survive without the operation P6 – A declared brain dead patient whose organs are being removed for donor purposes AA – Anesthesia services performed personally by anesthesiologist AD – Medical supervision by physician: more than four concurrent anesthesia procedures QK – Medical direction of two, three or four concurrent anesthesia procedures involving

qualified individuals QX – CRNA service: with medical direction by a physician QY – Medical direction of one certified registered nurse anesthetist (CRNA) by an

anesthesiologist Anesthesiologist medically directs 1 CRNA QZ – CRNA service: without medical direction by a physician

If the type of service is not anesthesia, the modifier must be one of the following, as applicable:

20 – Microsurgery 21 – Prolonged E & M service 22 – Unusual anesthesia service 24 – Unrelated E&M service by the same physician or other qualified healthcare

professional during a postoperative period 25 – Significant, separately identifiable E&M service by same physician or other qualified

healthcare professional on the same day of procedure or other service 26 – Professional component 32 – Mandated services 50 – Bilateral procedure 51 – Multiple procedures 52 – Reduced services 55 – Postoperative management only 56 – Preoperative management only 62 – Two surgeons 66 – Surgical team 75 – Concurrent care 76 – Repeat procedure by same physician or other qualified healthcare professional 77 – Repeat procedure by another physician or other qualified healthcare professional


78 – Unplanned return to operating/procedure room by the same or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period

79 – Unrelated procedure by same physician or other qualified healthcare professional during the postoperative period

80 – Assistant surgeon 81 – Minimum assistant surgeon 82 – Assistant surgeon (when qualified resident surgeon not available) 90 – Reference (outside) laboratory (Continued)

Listed below are valid modifiers according to CPT range:

CPT Range Valid Modifier 10000-69999 20, 22, 26, 32, 50, 51, 52, 54, 55, 56, 62, 66, 75, 76, 77, 78, 79, 80, 81, 82 70000-79999 22, 26, 32, 51, 52, 62, 66, 75, 76, 77, 78, 79, 80, 81, 82 80000-89999 22, 26, 32, 52, 90 90000-99100 22, 26, 32, 51, 52, 55, 56, 75, 76, 77, 78, 79 99201-99353 21, 24, 25, 32, 52, 78, 79

24E DIAG PT – The diagnosis pointers indicate which of the diagnosis codes (A-L) listed in block 21 apply to the procedure/service performed on each line of the claim. A maximum of four diagnosis pointers can be entered on each line of the claim.

Example: An entry of ‘B’ in the DIAG POINTER field identifies the diagnosis code entered in the DIAGNOSIS CODE B field as the primary diagnosis for that procedure.

An entry of ‘BK’ in the DIAG POINTER field identifies DIAGNOSIS CODE B field as the primary diagnosis for the procedure and DIAGNOSIS CODE K as secondary diagnosis for the procedure. If less than the entire field is used, use your arrow key to move to the next field.

24F AMTCHG – Enter the dollar amount charged for the service rendered. Entry must be numeric, greater than zero with no decimals indicated. If less than the entire field is used, use your arrow key to move to the next field.

24G DAYS OR UNITS – Indicate the number of times a procedure was performed or the number of visits the line item charge represents. If type of service is 07 (anesthesia), this field would also be used to indicate the NUMBER OF MINUTES the anesthesia was administered. Example: 15 minutes of administration should be entered as 15. Two hours and 15 minutes administration should be entered as 135. If less than the entire field is used, use your arrow key to move to the next field.

If billing for Weekly Radiation Therapy CPT codes 77419, 77420, 77425, 77430, 77431 or 77432 the TIMES field must be 001. These codes should be billed as separate line items.

24I ID QUAL – This is the rendering provider’s ID qualifier. This field is inactive and handled by BCBSLA in the electronic file.


24J RENDERING PROVIDER ID# – Enter the following provider identifiers:

NPI – Enter the complete 10-digit National Provider Identifier (NPI) of the physician who performed the services rendered. Do not enter the clinic’s NPI number in this field. The clinic’s NPI number should be entered in block 33, billing provider NPI.

Taxon – Select the 10-digit taxonomy code from the drop down box if required by the payer for adjudication.

Note: The taxonomy code edit “Rendering Provider Taxonomy Code Required” will occur when we are unable to locate a single match for the NPI number entered. The taxonomy code may assist us in locating a single match for the provider number entered.

Provider Type Taxonomy Code

Urology 203BU0002X Family Practice 207Q00000X Obstetrics and Gynecology 207V00000X Physical Medicine & Rehabilitation 208100000X General Practice 208D00000X Hospitalist 208M00000X Laboratories 291U00000X Ambulance 341600000X, 3416A0800X or 3416L0300X Chiropractor 111N00000X CRNA 367500000X Physical Therapy 225100000X Occupational Therapist 225X00000X Hematology & Oncology 207RH0003X Diagnostic Radiology Center 2085R0001X or 2085R0202X Emergency Room Physicians 207P00000X, 207PE0004X or 261QE0002X Infusion Therapy 251F00000X or 261QI0500X Home Infusion Therapy Pharmacy 3336H0001X Sleep Medicine 207RS0012X or 261QS1200X Urgent Care Center 261QU0200X Rural Health 261QR1300X Behavioral Analyst 103K00000X Social Worker 104100000X License Professional Counselor 101Y00000X Psychologist PHD 103T00000X Registered Nurse 166W00000X Audiologist 231H00000X


24K DRG – The National Drug Code (NDC) information is required for all physician administered drugs. We require an NDC on claims with J HCPCS codes and CPT codes for vaccines. We also require an NDC on a subset of S, Q and C HCPCS codes. Failure to appropriately report an NDC will result in automatic rejections with the front end edits below:

NDCREQD Rejection code when submitted with one of the identified medical drug codes, and the NDC is missing

INVNDC Rejection code when submitted with one of the identified medical drug codes, and the NDC is invalid. An invalid NDC is defined as not equivalent to 11 digits or an 11-digit code that is not found in the NDC database. Alpha characters, spaces or hyphens cannot be present.

NDC Code: Enter the 11-digit NDC. No alpha characters, spaces or hyphens can be

present.

Quantity: Numeric value of quantity

Measurement: Select the appropriate measurement from the drop down menu:

FR – International Units GR – Grams

ML – Milliliters UN – Units

More Line Items? – This field is used to indicate whether additional line items (more than the 10 line items already entered) will be needed to enter additional dates of service and charges for this particular claim. If additional line items are needed, select “Y” for yes. The claim will be edited; after acceptance, the 1500 claim form will be prefilled with all claims information except line items. Leaving this field blank will default to “N” for no.


Form Numbers 26 thru 33:

26 Patient’s Acct # – Enter the provider patient account number in this field. A maximum of nine positions may be used by the provider to identify the patient account; this number will be returned on the BCBSLA provider payment register. If less than the entire field is used, use your arrow key to move to the next field.

28 Total Charge – Enter the total of all charges entered in the CHARGE field columns. Total the charges for the first 10 line items even if more data is needed; entry must be numeric, greater than 0. Do not indicate decimal. If less than the entire field is used, use your arrow key to move to the next field.

32 Service Facility Location Information – The service facility location is not required by BCBSLA, but should be entered if known. The provider selected should be where the services were rendered. Refer to the Place of Service menu option for details on how to add a new service location.

33 Billing Provider Numbers:

33a NPI – Enter the complete 10-digit NPI assigned to the facility (MSS or ERP), physician, or physician group which will receive reimbursement for the services billed.

33b Taxonomy Code – Enter the corresponding taxonomy code from the drop down menu that corresponds with the provider’s type. The taxonomy code is used to determine the specialty of the provider and is required when we are unable to locate a single match for the NPI entered.


BCBSLA recognizes the following professional taxonomy codes:


Urology 203BU0002X Family Practice 207Q00000X Obstetrics and Gynecology 207V00000X Physical Medicine & Rehabilitation 208100000X General Practice 208D00000X Hospitalist 208M00000X Multi-Specialty Clinic 193200000X Laboratories 291U00000X Ambulance 341600000X, 3416A0800X or 3416L0300X Chiropractor 111N00000X CRNA 367500000X Physical Therapy 225100000X Occupational Therapist 225X00000X Hematology & Oncology 207RH0003X Diagnostic Radiology Center 2085R0001X or 2085R0202X Emergency Room Physicians 207P00000X, 207PE0004X or 261QE0002X Infusion Therapy 251F00000X or 261QI0500X Home Infusion Therapy Pharmacy 3336H0001X Sleep Medicine 207RS0012X or 261QS1000X Urgent Care Center 261QU0200X Rural Health 261QR1300X Behavioral Analyst 103K00000X Pharmacy 333600000X, 3336C0002X, 3336C0003X or

3336C0004X Durable Medical Equipment 332B00000X, 332BC3200X, 332BD1200X,

332BN1400X, 332BP3500X, 332BX2000X or 335E00000X

Nursing Home 376G00000X Note: The taxonomy code edit “Provider Taxonomy Code Required” will occur when we are unable to locate a single match for the NPI number entered. The taxonomy code may assist us in locating a single match for the provider number entered.

After entering all required fields, click the “Add Claim” button or press the “Enter” key. The claim will be edited; if any errors are detected, the error will appear.

If the claim is accepted, the patient account number, patient last name and first name will be displayed.


Ambulance Claims

When submitting an ambulance claim additional entry fields must be completed. The additional fields only display when an ambulance HCPCS code is entered into the CPT code field (block 24D). Otherwise this line of data fields remains hidden. See display below:

Ambulance Entry Fields:

Field Name Descripton

ATRC Ambulance Transport Reason Code (codes are available via link on the screen)

Trans Dist Transported Distance – enter the distance traveled during ambulance trip

Trip Purpose Round trip purpose description Ambulance Certified The condition indicator must equal “Y” if AMB Condition

code(s) is present and the code(s) apply to the line item charge. Otherwise indicator must be “N”

AMB Condition Ambulance Condition Indicator Codes (codes are available via link on the screen)


BCBSLA Professional Claim Entry Confirmation

When the claim has been entered as instructed, the operator may print a copy of the application and press the “Enter” key. If the claim has been accepted, “Claim Accepted For” will appear under the status bar on the claim entry form. The patient account number, patient last name and patient first names will be displayed.

If the claim contained errors, the edits will be listed at the top of the screen under the “Error Messages” section at the top of the screen. In order to correct the errors on the claim, refer to the Edit Section of this manual. Move to the problem field and correct the data. If the errors were corrected, the Claim Accepted confirmation will appear.

State Abbreviations

The following is a postal code list of states and their two-position abbreviations:

State Code State Code

Alabama AL Montana MT Alaska AK Nebraska NE Arizona AZ Nevada NV Arkansas AR New Hampshire NH California CA New Jersey NJ Colorado CO New Mexico NM Connecticut CT New York NY Delaware DE North Carolina NC District of Columbia DC North Dakota ND Florida FL Ohio OH Georgia GA Oklahoma OK Idaho ID Oregon OR Illinois IL Pennsylvania PA Indiana IN Rhode Island RI Iowa IA South Carolina SC Kansas KS South Dakota SD Kentucky KY Tennessee TN Louisiana LA Texas TX Maine ME Utah UT Maryland MD Vermont VT Massachusetts MA Virginia VA Michigan MI Washington WA Minnesota MN West Virginia WV Mississippi MS Wisconsin WI Missouri MO Wyoming WY


BCBSLA 1500 Professional Error Codes (Edits)

Error Code Resolution

NEED ANESTHESIA CPT FOR ANESTHESIA CLM

If CPT code is not equal to 00000-09999 and does not end with an alpha character and one of the following modifiers is present 23, 30, 47, P1, P2, P3, P4, P5, P6, P7, AA, AD, G8, G9, QK, QS, QX or QY. Modifier 1 cannot be empty.

ANESTHESIA MINUTES INVALID

Anesthesia minutes cannot be equal to 0 or 1, unless CPT code is equal to 01996, 01999, 01968 or 01995

ANESTHESIA MODIFIER REQUIRED

If CPT code begins with 00000-01995, 02000-09999, 01997 or 01998, one of the following modifiers must be present: AA, AD, QK, QX, QY or QZ. Modifier 1 cannot be empty

INVALID NEWBORN NAME

If filing a newborn’s claim, the PATIENT’S FIRST NAME cannot be BABY, GIRL, BOY, BOY1, BOY2, BOY3, BOY4, GIRL1, GIRL2, GIRL3, GIRL4, INFANT, TWIN, TWIN1, TWIN2, NEWBO, INFANT1, INFANT2, INFANT3, INFANT4, BAB, BAB1, BAB2, BAB3, BAB4, UNKNOWN, TRIPLET, BABY* (any name beginning with Baby) unless patients age is greater than one

BILLING NPI NOT ON FILE AT BCBSLA

The billing provider NPI number submitted cannot be located in the Blue Cross and Blue Shield of Louisiana provider system. Please send a copy of your NPI number along with your name and tax ID or Social Security number printed on your office letterhead by fax to (225) 297-2750 or by mail to BCBSLA: Attn. Network Administration: P.O. Box 98029; Baton Rouge, LA 70898-9029 or if you have any questions on the NPI in regard to your Blue Cross participation, contact us at 1-800-716-2299, option 3.

BILLING NPI DOES NOT MATCH THE TAX ID

The billing provider NPI number does not match the tax ID for the provider that is logged into iLinkBlue. Please verify that the data entered on the claim is valid; if correct, please send a copy of your NPI number along with your name and tax ID or Social Security number printed on your office letterhead by fax to (225) 297-2750 or by mail to BCBSLA: Attn. Network Administration: P.O. Box 98029; Baton Rouge, LA 70898-9029 or if you have any questions on the NPI in regard to your Blue Cross participation, contact us at 1-800-716-2299, option 3.

CPT4 01953 MUST ALSO HAVE 01952

If CPT code 01953 is present, then 01952 must be present.

CHARGE Entry in the CHARGE field must be numeric and greater than zero. INVALID CONTRACT NUMBER

The patient’s contract number is invalid

CONTRACT NUMBER MUST BE ENTERED

The patient’s contract number should not contain spaces or embedded spaces (will apply only to out of state contracts)



INVALID CPT4 CODE

Entry in the CPT field must be a valid code and valid for the date of service.

INVALID DIAGNOSIS CODE

The primary diagnosis code is invalid, not effective for the date of service or includes a decimal (remove decimal)


The secondary diagnosis code is invalid, not effective for the date of service or includes a decimal (remove decimal)


The tertiary diagnosis code is invalid, not effective for the date of service or includes a decimal (remove decimal)


The fourth diagnosis code is invalid or not effective for the date of service or includes a decimal (remove decimal)


The corresponding diagnosis code is invalid or not effective for the date of service or includes a decimal (remove decimal)

INVALID DIAGNOSIS CODE POINTER

The DIAGNOSIS POINTERS must be alpha characters A-L. The diagnosis pointer cannot point to a blank diagnosis code. The pointer should identify the diagnosis sequence that corresponds to the line item procedure.

INVALID TO DATE OF SERVICE

THRU date cannot be prior to the FROM date. The month must be 01-12, the day must be 01-31. If CPT 01996, 01997, 01999 are present, then service line from date must equal through date.

CPT 01968 MUST HAVE CPT4 01967

If CPT code 01968 is present, then CPT code 01967 must be present

INVALID FROM DATE OF SERVICE

The from date of service cannot be greater than the current date and must be in a valid format

FROM DOS IS GREATER THAN ENDING DOS

The from date of service cannot be greater than the thru date of service

CLAIM SPANS ICD10 DATE

1. For professional claims, the From and To dates cannot span the ICD-10 implementation date of October 1, 2015. Claim must be split as follows: a. All services prior to October 1, 2015, must be billed with ICD-9

codes b. All services on or after October 1, 2015, must be billed with ICD-

10 codes 2. For anesthesia claims where the procedure begins prior to October

1, 2015 and ended on October 1, 2015, the claim must be filed with September 30, 2015, as the start and end dates even if the procedure actually ended October 1, 2015. The claim should contain ICD-9 diagnosis codes.

**For details on filing ICD-9 and ICD-10 codes, see the section named “ICD-9 and ICD-10 Claims Filing Guidelines.”

ICN CLM NUMBER NOT ON BC FILE

The ICN number entered is invalid. The ICN number must be the original claim number



INVALID CPT4 MODIFIER COMBINATION

If CPT code 10000–69999 is present with a modifier, the modifier must be equal to 20, 22, 26, 32, 47, 50-56, 58, 59, 60, 62, 66, 74-82, 90 or 99

If CPT code is 90000-99100 is present with a modifier, the modifier must be equal to 21, 22, 24-27, 32, 51, 52, 55, 56-59, 75-79, 90 or 99

If CPT code is 99201 thru 99456 is present with a modifier, the modifier must be equal to 21, 22, 24, 25, 27, 32, 52, 55-59, 78, 79 or 90

INVALID NDC Professional claims submitted with a J HCPCS code, a CPT code for vaccines, or certain S, Q and C HCPCS codes will reject when the submitted NDC is invalid. An invalid NDC is defined as not equivalent to 11 digits or an 11-digit code that is not found in the NDC database. Alpha characters, spaces or hyphens cannot be present.

INVALID PAY PROVIDER

The billing provider number or pay provider number must be a valid BCBSLA provider or NPI number and approved for electronic submission through iLinkBlue by your location; or the valid BCBSLA provider number or NPI is not effective for the date of service on the line item

INVALID PLACE OF TREATMENT

Place of service must be equal to 01, 03, 04, 05, 06, 07, 08, 09, 13, 11, 12, 13, 14, 15, 16, 17, 20, 21, 22, 23, 24, 25, 26, 31, 32, 33, 34, 41, 42, 49, 50, 51, 52, 53, 54, 55, 56, 57, 60, 61, 62, 65, 71, 72 or 81

PATADDR NOT LA FILE TO OUTOFSTATE PLAN

The patient and/or the subscriber address in not Louisiana. The claim must be filed to the BCBS plan where the patient or subscriber resides.

MCRSUP The contract number entered is supplemental to Medicare. Please file Medicare primary.

INVALID CPT MODIFIER PCTC COMBINATION

Invalid modifier/CPT combination

INVALID CPT MODIFIER PCTC COMBINATION

Invalid modifier/CPT combination

INVALID MODIFIER POT COMBINATION

Invalid modifier/place of treatment combination

MULTIPLE BCBSLA BILLING PROVIDER IDS FOUND

The billing provider NPI number resulted in multiple matches on our BCBSLA provider number file. Please verify that the billing NPI entered on the claim is valid; if correct, please send a copy of your NPI number along with your name and tax ID or Social Security number printed on your office letterhead by fax to (225) 297-2750 or by mail to BCBSLA: Attn. Network Administration: P.O. Box 98029; Baton Rouge, LA 70898-9029. If you have any questions on the NPI in regard to your Blue Cross participation, contact us at 1-800-716-2299, option 3.



MULTIPLE BCBSLA RENDERNIG PROVIDER IDS FOUND

The rendering provider NPI number resulted in multiple matches on our BCBSLA provider number file. Please verify that the billing NPI entered on the claim is valid; if correct, please send a copy of your NPI number along with your name and tax-ID or Social Security number printed on your office letterhead by fax to (225) 297-2750 or by mail to BCBSLA: Attn. Network Administration: P.O. Box 98029; Baton Rouge, LA 70898-9029. If you have any questions on the NPI in regard to your Blue Cross participation, contact us at 1-800-716-2299, option 3.

NPI of the supervising physician and the appropriate modifier code AN or AS.

NDC CODE REQUIRED

Professional claims submitted with a J HCPCS code, a CPT code for vaccines, or certain S, Q and C HCPCS codes will reject when the NDC is missing.

PERF PROV CANNOT CLINIC

The performing provider number cannot be the clinic number

INV OR BLANK PERF PROVIDER NUM

The performing provider number is not on file at BCBSLA

INVALID POS CPT4 COMBINATION

The place of service must be compatible with the CPT code as indicated in the guideline below:

CPT Code Place of Service 99201-99215 03, 04, 05, 06, 07, 08, 11, 12, 13, 14, 15, 17, 20, 22, 23, 24, 25, 26, 40, 49, 50, 52, 53, 54, 62, 65, 71, 72, 81 99221-99239 06, 08, 21, 22, 23, 24, 25, 32, 51, 52, 55, 56, 61, 62 99241-99245 05, 06, 07, 08, 11, 15, 22, 23, 24, 26, 32, 34, 49, 50, 53, 54, 62, 65, 71, 72, 81 99251-99263 21, 22, 23, 24, 25, 32, 51, 52, 55, 56, 61, 62 99281-99288 22, 23, 24 99301-99333 31, 32, 33 99341-99353 04, 12,13, 14, 33, 34

INVALID PREFIX FOR DATE OF SERVICE

Contract number prefix is invalid for date of service. (will apply only to out of state contracts)

PRVIRS The rendering provider is not currently setup in the BCBSLA system with the tax ID filed on the claim. Verify tax ID submitted on the claim.

BPROV NOT LA FILE TO OUTOFSTATE PLAN

This is a durable medical equipment claim and the place of service is not 04, 09, 12, 13, 14, 34 or 55 and the service facility field is blank. In addition, the BCBSLA provider file or the NPPES provider file indicates that the billing provider is not Louisiana based on the billing provider’s NPI. The claim must be filed to the BCBS plan serving the area where the billing provider is physically located.

REFNPINV This is a clinical lab claim with a place of treatment 81. The NPI of the referring physician is invalid in the BCBSLA provider file and is also invalid



NPPES (National Plan Provider Enumeration system) Please correct the referring physician NPI in FL17b and resubmit your claim

REFNPIRQ This is a clinical lab claim with a place of treatment of 81. A referring physician NPI is required in FL 17b.

REFSTATE This is a clinical lab claim with a place of treatment of 81 and the BCBSLA provider file or the NPPES provider file indicates that the referring provider’s physical location is not Louisiana. The claim must be filed to the BCBS plan where the referring provider is located.

RENDERING NPI DOES NOT MATCH THE TAX ID

The rendering provider NPI number does not match the tax ID for the provider that is logged into iLinkBlue. Please verify that the data entered on the claim is valid; if correct, please send a copy of your NPI number along with your name and tax ID or Social Security number printed on your office letterhead by fax to (225) 297-2750 or mail to BCBSLA: Attn. Network Administration: P.O. Box 98029; Baton Rouge, LA 70898-9029, or if you have any questions on the NPI in regard to your Blue Cross participation, contact us at 1-800-716-2299, option 3.

RENDERING NPI NOT ON FILE AT BCBSLA

The rendering provider NPI number submitted cannot be located in the Blue Cross and Blue Shield of Louisiana provider system. Please send a copy of your NPI number along with your name and tax ID or Social Security number printed on your office letterhead by fax to (225) 297-2750 or by mail to BCBSLA: Attn. Network Administration: P.O. Box 98029; Baton Rouge, LA 70898-9029 or if you have any questions on the NPI in regard to your Blue Cross participation, contact us at 1-800-716-2299, option 3.

SEP DOS The from and thru date must be equal when CPT code is equal to 95115, 95117, 95120, 95125, 95130, 95131, 95132, 95133, 95134, 95144, 95146, 95147, 95148, 95149, 95165, 95170, 95180 or 95199

SVCSTATE The NPI for the service facility in FL32b is not Louisiana based on the BCBSLA provider file or the NPPES provider file. The claim must be filed to the BCBS plan where the service facility is located.

SEXCPT Sex cannot be male if the following CPT codes are listed on the claim: 19160, 19180, 19182, 19220, 19316, 19318, 19324, 19325, 19330 or 56405-59899. Sex cannot be female if the following CPT codes are listed on the claim: 19140, 52649 or 54000-55899.

TAXONOMY CODE REQUIRED

The taxonomy code edit will occur when we are unable to locate a single match for the NPI number entered. The taxonomy code may assist us in locating a single match for the provider number entered.

TOTALCHG The Total Charge field must equal the sum of all line item charges. UNITS REQUIRED ON ALL SERVICE LINES

Unit count cannot be blank or equal to zero


National Provider Identifier Edits

Billing NPI not on file at BCBSLA The billing provider NPI number submitted cannot be located in the Blue Cross and Blue Shield of Louisiana provider system. Please send a copy of your NPI number along with your name and tax ID or Social Security number printed on your office letterhead by fax to (225) 297-2750 or by mail to BCBSLA: Attn. Network Administration: P.O. Box 98029; Baton Rouge, LA 70898-9029 or if you have any questions on the NPI in regard to your Blue Cross participation, contact us at 1-800-716-2299, option 3.

Rendering NPI not on file at BCBSLA The rendering provider NPI number submitted cannot be located in the Blue Cross and Blue Shield of Louisiana provider system. Please send a copy of your NPI number along with your name and tax ID or Social Security number printed on your office letterhead by fax to (225) 297-2750 or by mail to BCBSLA: Attn. Network Administration: P.O. Box 98029; Baton Rouge, LA 70898-9029 or if you have any questions on the NPI in regard to your Blue Cross participation, please contact us at 1-800-716-2299, option 3.

The line number in the error indicates which rendering provider NPI is not located on the BCBSLA provider system.

Multiple BCBSLA Billing Provider IDs Found The billing provider NPI number resulted in multiple matches on our BCBSLA provider number file. Please verify that the billing NPI entered on the claim is valid; if correct, please send a copy of your NPI number along with your name and tax ID or Social Security number printed on your office letterhead by fax to (225) 297-2750 or by mail to BCBSLA: Attn. Network Administration: P.O. Box 98029; Baton Rouge, LA 70898-9029. If you have any questions on the NPI in regard to your Blue Cross participation, contact us at 1-800-716-2299, option 3.

Multiple BCBSLA Rendering Provider IDs Found The rendering provider NPI number resulted in multiple matches on our BCBSLA provider number file. Please verify that the billing NPI entered on the claim is valid; if correct, please send a copy of your NPI number along with your name and tax ID or Social Security number printed on your office letterhead by fax to (225) 297-2750 or by mail to BCBSLA: Attn. Network Administration: P.O. Box 98029; Baton Rouge, LA 70898-9029. If you have any questions on the NPI in regard to your Blue Cross participation, contact us at 1-800-716-2299, option 3.


Billing NPI does not match the Tax ID The billing provider NPI number does not match the tax ID for the provider that is logged into iLinkBlue. Please verify that the data entered on the claim is valid; if correct, please send a copy of your NPI number along with your name and tax ID or Social Security number printed on your office letterhead by fax to (225) 297-2750 or by mail to BCBSLA: Attn. Network Administration: P.O. Box 98029; Baton Rouge, LA 70898-9029 or if you have any questions on the NPI in regard to your Blue Cross participation, contact us at 1-800-716-2299, option 3.

Rendering NPI does not match the Tax ID The rendering provider NPI number does not match the tax ID for the provider that is logged into iLinkBlue. Please verify that the data entered on the claim is valid; if correct, please send a copy of your NPI number along with your name and tax ID or Social Security number printed on your office letterhead by fax to (225) 297-2750 or by mail to BCBSLA: Attn. Network Administration: P.O. Box 98029; Baton Rouge, LA 70898-9029 or if you have any questions on the NPI in regard to your Blue Cross participation, contact us at 1-800-716-2299, option 3.

Taxonomy Code Required The taxonomy code edit will occur when we are unable to locate a single match for the NPI number entered. The taxonomy code may assist us in locating a single match for the provider number entered.

BCBSLA recognizes the following professional taxonomy codes:


Emergency Room Physicians 207P00000X, 207PE0004X or 261QE0002X

Medical Staff Services 282N00000X

Sleep Medicine 207RS0012X or 261QS1000X

An all-inclusive list of the taxonomy codes can be located on the WEDI website; www.wedi.com.


BCBSLA Screen Pop Edits

The following are a list of the screen pop edits that are required to ensure that claims are HIPAA compliant. These edits are presented when the user is using Internet Explorer as the web browser for the iLinkBlue application. Other browsers such as Mozilla Firefox and Google Chrome may impact the display of these edits in the user’s web browser.

Screen Pop Edit Error Reason

Please Enter a Numeric Value In all Dollar Amount fields, a numeric value is the only value allowed

Amount over $99,999,999.99 The line item charge or total charge of the claim cannot be over $99,999,999.99

Amount charged , Line item can only contain numeric values

Amount charged, line item can only contain numeric values

Total Charge can only contain numeric values

Total Charge can only contain numeric values

Please Enter a Valid Date All date fields must contain a valid value Please Enter a Valid Date in the Format MMDDYYYY

All date fields must contain a valid date format MMDDYYYY

Cannot Enter Information on a line following a blank line

Cannot enter information on a line item when the previous line item is blank

Cannot Have a Blank Line Item Here Cannot skip between line items Special characters are not allowed in this field

There are multiple fields programmed and special characters are not allowed; please remove the special characters and resubmit claim

Insured’s ID Missing The insured’s ID is required in FL 1a Patient’s Last Name Missing The patient’s last name is required Patient’s First Name Missing The patient’s first name is required Patient‘s State Invalid The patient’s state is required Patient’s City Missing The patient’s city is required Patient’s ZIP Code Invalid The patient’s ZIP Code is required Patient’s Date of Birth Missing The patient’s date of birth is required Patient’s Relationship to Insured Missing

The patient relationship to insured is required

Patient’s Sex Missing The patient’s sex is required Patient’s Street Address Missing The patient’s street address is required Insured’s Last Name Missing The insured’s last name is missing Insured’s First Name Missing The insured’s first is required Insured’s Street Address Missing The insured’s street address is required Insured’s City Missing The insured’s city is required Insured State Invalid A valid state code must be present for the insured Insured ZIP Code invalid The ZIP code entered for the insured is not a valid

ZIP code



Verify Other Insured Exists Confirm that the other insured information is present since claim indicates other insured information is present

Only alphabets A – L are allowed Diagnosis pointer (block 24EJ)can only contain alphas A – L

Other Insured date of birth missing Other insured date of birth must be present Other Insured Sex Missing Other insured sex must be present Other Insured Last Name Missing Other insured last name must be present Other Insured First name missing Other insured first name must be present Other Insured Policy Group number missing

Other insured Policy Group number must be present

Other Insured Relationship code missing

Other insured relationship code must be present

Other Insured Insurance Plan Name Missing

Other insured insurance plan name must be present

Duplication Character not allowed on the first line item

The first line item cannot contain the duplication character of *

Patient Account Number Missing The patient account is required Patient control number may not contain the asterisk(*) characters

Patient control number may not contain the asterisk (*) characters

Patient control number may not contain the question mark ?

Patient control number may not contain the question mark ?

Patient control number may not contain the left parenthesis (

Patient control number may not contain the left parenthesis (

Patient control number may not contain the right parenthesis )

Patient control number may not contain the right parenthesis )

Patient control number may not contain a space

Patient control number may not contain a space

Patient control number may not contain the ampersand &

Patient control number may not contain the ampersand &

Release of Info Indicator Invalid Patient or authorized person’s signature is required in FL12

Assignment of Benefits Indictor Invalid

Insured’s or authorized person’s signature is required in FL13

Cannot skip between diagnosis codes Cannot skip between diagnosis codes At least one line item must be entered

At least one line item must be entered

Ambulance Transport Code Missing on Line

Ambulance transport code missing on Line – this edit will identify which line item the error is on

Ambulance Transport Reason Code Missing on Line

Ambulance transport reason code missing on Line– this edit will identify which line item the error is on

Ambulance Transport Distance Missing

Ambulance transport distance must be present



Auto Accident State Invalid Auto accident state must be a valid state code Billing Provider’s ID Missing Billing provider number in FL33 is required Billing Provider’s NPI must be 10 digits

Billing provider NPI must be 10 digits

Billing Provider’s NPI must be all Numbers

Billing providers NPI must be all numbers

Referring Physician’s Last Name Missing

Referring physician’s last name must be present

Referring Physician’s first name missing

Referring physician’s first name must be present

Referring Physician’s ID Missing Referring physician’s ID must be present Referring Physician’s Last Name Missing

Referring physician’s last name must be present

Referring Physician’s NPI must be 10 digits

Referring physician’s NPI must be 10 digits

Referring Physician’s NPI Must be all numeric

Referring physician’s NPI must be all numeric

Rendering Provider’s ID missing on Line

Rendering providers ID missing on Line – this edit will identify the line item the error is on

Rendering Providers NPI must be 10 digits on Line

Rendering Providers NPI must be 10 digits on Line - this edit will identify which line item the error is on

Rendering Providers NPI must be all number on line

Rendering Provider’s NPI must be all number on line- this edit will identify which line item the error is on

NPI Values must be numeric NPI values must be numeric NPI Numbers must be 10 digits NPI numbers must be 10 digits Please make sure all fields contain data

This edits is checking all of the address fields

Please Make sure all fields contain data

This edit is checking the NPI provider information

Select ICD Indicator Value Block 21 – ICD indicator is required and must be selected

ICD Indicator of 9 Required If your date of service is prior to October 1, 2015, and you choose an ICD-10 indicator this edit will be triggered

ICD Indicator of 0 Required If your date of service is on or after October 1, 2015, and you choose an ICD-9 indicator this edit will be triggered


Service Facility Location Information (place of service file)

The Service Facility Location Information menu option will allow you to enter the place of service information that is linked to the drop down menu in FL32, Service Facility, on the claims entry screen. The place of service is the name and physical address of where the actual services were rendered.

Below are instructions on how to complete the Service Facility Location Information screen:

Enter the facility NPI in the NPI field Enter the facility name and complete physical address. (P.O. Boxes are not acceptable) Click “Submit” Continue to enter all facility names and physical addresses where your physicians render

services. The facility info will be retained and available when entering claims. To select the address for rendering service facility, use the drop down box selection on the entry screen in block 32.

If entering a new facility name while entering a 1500 claim, you must refresh the entry screen after entering the facility information in order for the drop box to be populated with the new data

To update an existing service facility location:

Click on the field that needs to be updated Make the necessary changes Click “Edit”


FACETS Edit Descriptions

Short Edit Description Long Edit Description

ANES_CPT NEED ANESTHESIA CPT FOR ANESTHESIA CPT CLM ANESMIN ANESTHESIA MINUTES INVALID ANESMOD ANESTHESIA MODIFIER REQUIRED BABYNAME INVLAID NEWBORN NAME BURN CPT4 01953 MUST ALSO HAVE 01952 CHARGE INVALID LINE ITEM CHARGE CONT_INV INVALID CONTRACT NUMBER CONTNO CONTRACT NUMBER MUST BE ENTERED CPT4 INVALID CPT4 CODE DIAGA INVALID DIAGNOSIS CODE DIAGB SECONDARY DIAGNOSIS CODE INVALID DIAGC TERTIARY DIAGNOSIS CODE INVALID DIAGD FOURTH DIAGNOSIS CODE INVALID DIAGE - L DIAGNOSIS CODE INVALID DIAG_PTR INVALID DIAGNOSIS CODE POINTER EDOSAA INVALID DATE OF SERVICE EPID CPT 01968 MUST HAVE CPT 01967 FDOS INVALID FROM DATE OF SERVICE FDS EDS FROM DOS IS GREATER THAN ENDING DOS ICDSPLIT CLAIM SPANS ICD10 DATE INVCPTMD INVALID CPT4 MODIFIER COMBINATION INVNDC INVALID NDC INVPAYPN INVALID PAY PROVIDER INVPOT INVALID PLACE OF SERVICE MCRSUP CONTRACT SECONDARY TO MEDICARE MEMSTATE PATADDR NOT LA FILE TO OUTOFSTATE PLAN MODC01 INVALID CPT MODIFIER PCTC COMBINATION MODDM INVALID CPT MODIFIER PCTC COMBINATION MODPT INVALID MODIFIER POT COMBINATION NAME_CON PAT NAME DOES NOT MATCH NAME ON BCSYS NDCREQD NDC CODE REQUIRED PATDOBYR PAT DOB YEAR NOT ON BC FILE PATLSTNM PAT LAST NAME NOT ON BC FILE PATFSTNM PAT FIRST NAME NOT ON BC FILE PDOBVLDT PATIENT DATE OF BIRTH MUST BE A VALID PERFCLNC PER PROV CANNOT CLINIC PERFPROV INV OR BLANK PERF PROVIDER NUM POTCPT4 INVALID POS CPT4 COMBINATION


Short Edit Description Long Edit Description

PREFX INVALID PREFIX FOR DOS PRVSTATE BPROV NOT LA FILE TO OUTOFSTATE PLAN REFNPIRQ REFERRING PROVIDER NPI REQUIRED REFNPINV REFERRING PROVIDER NPI INVALID REFSTATE REFPROV NOT LA FILE TO OUTOFSTATE PLAN SEP DOS FILE EACH DOS SEPARATELY SEXCPT INVALID PATIENT SEX CPT TOTALCHG INVALID TOTAL CHARGE UNITREQD UNITS REQUIRED ON ALL SERVICE LINES UNITS ACTUAL NUMBER OF UNITS REQUIRED


Professional Claims Entry Manual Revision History

The revision history is included in this guide to provide an overview of changes that have been made when a newer version of the guide is published in iLinkBlue. The revision history is intended to provide a snapshot description of the change(s) along with the date the revision was made (internally) along with the department responsible for the revision.

Revision Description Approved

Date Department Writer

Receive date added to Pended Claim Detail screen, multiple ineligibles, subscriber pay claims do not display, researching Blue Cross contracts

12/21/2001 EDI Christina Kendrick

Removed Ambulance as exception to entry. Block 7 – (Address) must be completed on

all claims Block 9 – (Other Insured’s information) must

be completed if 11d is ‘Y’ Block 10b and 10c – (Is Patient’s Condition

Related To?) must be completed for accident ICD-9 codes.

Block 14 – (Date of Current) now used to report LMP date

Block 17 – Name of Referring Physician must be entered if a prior authorization number is present in block 23.

Block 18 – (Hospitalization Dates) required for the place of treatment codes specified.

Block 23 – (Authorization Date) Block 24 c – Type of Service is not required Block 24i – Emergency Related Block 32 – Name and Address of Facility

Where Services Were Rendered Ambulance Entry Fields – Added edits:

ACCDST, CNDREL, HOSPOS, LNPAYE, FNPAYE, SPAYE, OTCON, DOBPAY


Added new FACETS Edits. Edits in Blue are specific for the FACETS

Claims Edits in Red are the same for FACETS &

Legacy Claims Edits in Black are for the Legacy Claims only

Note: Some FACETS & Legacy claims edits may have different short descriptions, but the same program/coding logic is used.

12/1/2005 EDI Lynn Fairchild




Removed the following Type of Service Edits, field is not active:

TP SV TSCPT TSMOD MOD TIMES—removed type of service logic

Removed all verbiage in the manual that applies specifically to type of service. Type of service is not an active field on the BC 150 claims entry screen.

EMG Coding Section-updated verbiage if Facets contract number entered.


Update manual to include updates for the new 1500 claim form changes and National Provider Identifier, NPI updates.


Updated the following edits to include the NPI verbiage: PROVSAA, INVPAYPN, PERFCLNC, PERFPROV, INDPERP, INVPERF, PABLK, PAY10, PERF10

Deleted Place of Service File Section. This is not required by BCBSLA. The field is inactive on the entry screen.

Updated FL17B, 24J, & 33 to include NPI verbiage and the fields are active.


Added NPI only edits to manual and updated information in the Billing Rendering & Referring provider blocks. Added taxonomy code field to entry section.


Updated screen shots and manual for NPI only changes. Removed all legacy number fields and added taxonomy code logic.


Updated logic for some FACETS edits; deleted FACETS edits that are not in production based on list from IT

Deleted Paper Edits: CONT_DOB, CONT_REL, NAME_CON, TIMES, TIMES01

Deleted Edit not in production: INV PSIG, RELINV, UNSPECCPT





Added ITS/Hosts Edits 09/19/2008 EDI Debbie Rowley

Updated notes on service facility; field was activated


Updated information FL32, Service Facility and added information on how to complete the place of service screen.


Added new ITS edit for Units Required 07/18/2011 EDI Dietra Wilson Removed “UNIT” edit and replaced with “UNITREQD”

Added new POT codes to the edit “INVALID POS CPT4 COMBINATION”

10/11/2011 EDI Dietra Wilson

Added Ancillary edits, REFNPIRQ, REFNPINV, REFSTATE, MEMSATE, SVCSTATE, and PRVSTATE

10/10/2012 EDI Dietra Wilson

Updated Formatting 03/18/2013 EDI Lynn Fairchild

Removed FL9b instructions, this field was deactivated

Added information FL19a Adj/Void Indicator

Added information FL19b ICN#

Added a note for FL21 Diagnosis Codes

Updated list of Place of Service Codes

Added information for new FL24J Rendering Provider Taxonomy

Added information for new FL24K DRG

Removed ATC field for Ambulance this is no longer required

Added to DIAG error codes to remove decimal

Added new error code INVICN

Removed all legacy edits

Add Screen Pop edits (which edits)

Removed the Claims Entry Options System Messages

02/13/2014 EDI Debbie Rowley/ Dietra Wilson

Added Front End Screen pop edits against developers list





Updated screenshots throughout

Updated block 9 information

Added block 10d information

Updated block 21 information

Updated block 24E information

Updated DIAG edit A-L

Updated DIAG_PTR

Added screen pop

Updated Edits descriptions list


Added taxonomy codes for rendering and billing provider


Updated the rendering and billing provider taxonomy code list to reflect the new taxonomy codes entered in the taxonomy codes table on 09/26/2014


Corrected taxonomy code for GT 80 Sleep Medicine

07/24/2015 EDI Mary Fielder

Added ICD-9/ICD-10 claims filing rules, ICD indicator, ICDSPLIT edit, updated ICD references


Added PRVIRS edit that was omitted out of the manual


Added INVNDC and NDCREQD edit info, and new NDC requirements

08/10/2016 EDI Faith Mallett

Updated overall look of document including formatting, logo, tagline and general look of content and new cover design

Updated iLinkBlue screen shots

Removed section on “How to Validate a Prefix”

Removed duplicate “Anesthesia Claims Rules” table

Updated BCBSLA 1500 Professional Error Code Edits

02/27/2017 Prov Comm Michelle Miller

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Transcript of iLinkBlue 1500 Claims Entry Manual Claims Entry Manual.pdf · FACETS Edit Descriptions ... (NASCO)...