Wiki DME and BlueCard program

[ramzeee68]

I'm new to DME coding and billing. I have a question regarding DME and the BlueCard program. If a patient who receives a DME supply outside of the DME company's state, do I bill our local BCBS even if we are not contracted, or do I bill the patient's home plan? I cannot find anything on the BCBS Associations website that specifies where to bill the claim. Also if I go onto a specific state BCBS website they tell me something different. Any help would be greatly appreciated.

 

[thomas7331]

I worked in Blue Card many years ago and things have probably changed a lot since then, but the general rule was that providers had to submit claims to their local plan, regardless of whether or not they were contracted. Some home plans will pay out-of-network claims to the provider directly, but usually those claims are received from the host plan, not from the provider. If you send it directly to the home plan, there's a high likelihood that whomever first gets the claim and sees and out-of-state address for your provider will simply return the claim to you and ask you to submit locally. Unless the patient's insurance card instructs to submit out-of-network claims directly to the home plan's address, I would recommend you start with your local plan and work with them if there is a problem processing the claim. Hope that helps some.