[PDF] Blue Cross Blue Shield of Michigan HIPAA EDI Companion

How do I request a claim status connection to a payer?

Assurance™ EDI - Claim Status Payer List To request a claim status connection to a payer not on the list below, please submit a New Payer Connection Request. Reference the CAQH web site for CORE Certified payers.

What is the Federal Tax ID number for a billing provider?

Enter the “Federal Tax ID Number” (employer ID number or SSN) of the Billing Provider identified in Item Number 33. This is the tax ID number intended to be used for 1099 reporting purposes.

What blocks must be completed when submitting a CMS 1500 or UB-04 claim?

The following blocks must be completed when submitting a CMS 1500 or UB-04 claim form for a complete EPSDT screen: ? EPSDT Referral Codes (when a referral is necessary, use the listed codes in the example below to indicate the type of referral made) ? Diagnosis or Nature of Illness or Injury 80

What are the national coverage determination modifiers for erroneous surgery?

The claim must include the appropriate modifier appended to all lines that relate to the erroneous surgery or procedure using one of the following applicable National Coverage Determination modifiers: o PA – surgery wrong body part o PB – surgery wrong patient o PC – wrong surgery on patient