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39 11/2005
• Submit therapy charges with the number of units equal to the number of
days these services were rendered and not the number of modalities per
service.
• Check formatting and print quality of hard-copy claims before submission.
Unaligned data elements and light print may prevent your claims from being
processed.
• Include primary payment information with coordination of benefits (COB)
claims submitted for secondary payment.
• Obtain required pre-authorizations and include the pre-authorization
number on the claim.
• Use the prefix given on the member ID card prior to the member
identification number.
• Verify eligibility and benefit limits before rendering services.
• Rubber-stamp the type of claim (e.g. adjustment, corrected bill, tracer, etc.)
on the face of hard-copy bills to ensure correct identification. Do not use
red ink when stamping, because the scanning equipment may not be able to
read this information.
• Check the back of the patient’s insurance card for the correct mailing
address for hard copy claim submissions.
Common reasons for rejected claims (i.e., claims that cannot be processed by
BCBSGa/BCBSHP):
• Outdated, incomplete or non-specific ICD-9, HCPCS and/or CPT codes on
the claim.
• Incomplete data elements.
• Invalid or incorrect contract information (i.e. member number).
• Ineligible member for BCBSGa/BCBSHP coverage.
• Illegible hard-copy claims.
Note: Rejected hardcopy claims will be mailed back to the sender along with
a request for additional information that is necessary to process the claim.
Types of claims that should not be submitted electronically:
• Claims for reimbursement contracts that require itemized bills or invoices to
be submitted with the claims.
• Claims with late charges.