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December 21, 2021

BCBSKS (47163) expanding Ordering and Referring Provider edits

Beginning 12/21/2021 the submission of Ordering OR Referring provider information will be required 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 OR 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.

If you have questions regarding Policy Memos 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 1-800-472-6481 option 1, then 2.

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