February 20, 2014
BCBSKS expanding Ordering and Referring Provider Edits
BCBSKS requires the submission of Ordering and Referring provider information on 837 Professional claims with a radiology procedure, laboratory service, diagnostic or HCPC (excluding Ambulance).
Referring provider information must be submitted in the 2310A and/or 2420F and Ordering provider information must be submitted in the 2420E, or the claim will reject. Please refer to the 837P TR3/Implementation Guide or contact your vendor for more information.
Edit logic can be found in the ASK Professional Edit Documentation (no longer available), please note you will need the Claim Status Category Code and Claim Status Code returned on the 277CA.
If you have questions regarding Policy Memo No. 1 contact your BCBSKS Professional Relations Representative or call Provider Network Services at 1-800-432-3587. If you have questions regarding the 837 Professional transactions contact the EDI Help Desk at 1-800-473-6481 option number 1.