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38 11/2005
Claim Submission
BCBSGa/BCBSHP participating facilities are required to accept the member’s ID card in
lieu of payment up-front and to file claims for members.
Hospitals are encouraged to file members’ claims electronically. Hospitals who file
hardcopy claims for reimbursement for services rendered to members should use
standard UB-92 claim forms.
The following data is required for submitting electronic and/or hardcopy claims to
BCBSGa/BCBSHP:
• Current ICD-9 diagnosis and procedure codes, HCPCS and CPT procedure
codes. (There should be only one procedure code per line and codes should
be listed to the fifth digit. HCPCS and CPT procedure codes should include
modifiers where applicable.)
• Valid revenue codes.
• Correct and valid bill types, per the UB-92 Billing Manual.
• Complete coded bills, per the UB-92 Billing Manual. The following are
examples of significant data elements:
Place of service and type of service
Procedure and diagnostic codes
Provider name and tax ID
Dates of service
• Complete and accurate patient and insurance information including:
Alpha prefix and numeric suffix with member number.
Correct spelling of the patient’s name.
Date of birth and sex of patient.
Additional information for submitting claims to BCBSGa/BCBSHP:
• Include CPT codes for revenue codes such as radiology, pathology and
surgery.
• Include the actual CPT code only once for each revenue line.
• Submit all revenue codes with a dollar value.