Real-time claim adjudication is here!On May 19, 2008, Blue Cross and Blue Shield of Florida, Inc. (BCBSF) introduced to individual professional providers the first tool in the health care industry to combine patient eligibility and financial responsibility with real-time claim adjudication.
Submit corrected claims electronicallyPhysicians and providers using electronic data interchange (EDI) or batch processing can now electronically submit corrected claims to Blue Cross and Blue Shield of Florida (BCBSF) using the Availity®1 Health Information Network.
Evaluation and Management reimbursement policy updatedOn June 28, 2008, Blue Cross and Blue Shield of Florida, Inc./Health Options updated its reimbursement policy for a problem-oriented evaluation and management (E/M) code billed with a preventative medicine E/M code on the same date of service for the same patient.
Use established visit codes for members seen within 3 years of a previous visitAccording to Current Procedural Technology (CPT), a new patient is one who has not received any professional services from the physician, or another physician of the same specialty that belongs to the same group practice, within the past three years. The new patient visit CPT codes are 92002, 92004, 99201-99205, 99324-99328, 99341-99345 and 99381-99387. The new patient visit HCPCS codes are G0245, S0610 and S0620.
Avoid overpayments on UB-04 paper claimsQuite often when submitting a paper (UB-04) claim, providers add a summary line totaling the lines and codes billed on the claim. However, a summary line is not a required element of claims submission, and its inclusion can cause overpayments.