BlueChoice HealthPlan continues to ask for medical records and consent forms. We are an ancillary service provider, and do not know or see a patient until we administer anesthesia in the operating/procedure room. Why can’t BlueChoice® pay our claims and withhold payment from the surgeon who has the medical records? Please continue to return the medical records requests to us with the referring/rendering providers’ names included. We cannot withhold payment from the surgeon because these are not global charges. We need the medical records to reimburse any professional provider in this situation.
Where do I submit the claim if I am using home as the place of service and there are several out-of-state addresses shown? Wherever the member receives the item is where you should bill it. For example, if a patient is visiting South Carolina then you should bill to BlueChoice HealthPlan of South Carolina. When filing claims, the place of service is 12 for home and 99 for other. For more information please see our provider news bulletin Ancillary Provider Reminders on our website. We receive blood samples from all over the country.
Can we file to a BlueChoice plan in another state? Yes, you can file to another Blue Plan. A laboratory provider can file claims where the specimen was collected or where the referring physician is located.
Should we notify members you will bill them if they visit an out-of-network lab? Yes, we require you to inform members we may bill them for for use of a non-participating lab.
Should providers file lab claims to Host or Home Plan? Lab claims should be filed to the plan where the ordering or referring physician is located.