Filing Guidelines for Air Ambulance Providers

Filing Guidelines for Air Ambulance Providers

4/7/2015

Generally, as a health care provider, you should file claims for your BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina patients to BlueCross or BlueChoice® as your local Plan. There are unique circumstances, however, when claims filing directions will differ based on the type of provider and service.

Effective April 19, 2015, you must file claims for air ambulance services to the Blue Plan in whose service area the point of pickup ZIP code is located.

If you contract with more than one Plan in a state for the same product type [i.e., preferred provider organization (PPO) or traditional], you can file the claim with either Plan.

 

Service Rendered  How to File (Required Fields) Where to File Example
Air Ambulance Services

Point of Pickup ZIP Code:

CMS 1500 Health Insurance Claim Form

- Enter the five-digit point of pickup ZIP code in field 23.

837 Professional Electronic Submission

- Enter the five-digit point of pickup ZIP code in loop 2310E.

- Enter the five-digit drop off location ZIP code in loop 2310F.

UB-04 Institutional Claim Form

- Enter the condition code AK and value code A0 with the five-digit point of pickup ZIP code in fields 39-41.

837 Institutional Electronic Submission

- Enter the condition code AK and the value code AO with the five-digit point of pickup ZIP code in loop 2300.

 

 

File the claim to the Plan in whose service area the point of pickup ZIP code is located.

 

The point of pickup ZIP code is in Plan A service area.

File to: Plan A, based on the point of pickup ZIP code.

  1. The air ambulance claims filing rules apply regardless of the provider’s contracting status with the Blue Plan where the provider filed the claim.
  2. We encourage providers to verify member eligibility and benefits by contacting the phone number on the back of the member ID card or calling 800-676-BLUE.
  3. Providers that use outside vendors to provide services should use in-network participating air ambulance providers to reduce the possibility of additional member liability for covered benefits. 
  4. Members are financially liable for air ambulance services their benefit plans do not cover. It is the provider’s responsibility to request payment directly from the member for non-covered services.  

If you have any questions about where to file your claim, please contact Provider Education at 800-288- 2227, ext. 44730 or email us at provider.education@bcbssc.com.

BlueCross® BlueShield® of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.