Updates to PPO professional and outpatient claim editing process coming in December

Starting in December 2018, Blue Cross Blue Shield of Michigan will update its professional and outpatient facility PPO claim editing processes for select groups. We’re doing this to promote correct coding.

These improvements will make our claims payment system easier for you and your billing staff to navigate. Unique clinical editing reason codes will appear on the 835 response files or provider vouchers.

As a reminder, when billing PPO claims, you should follow guidelines from:

• The American Medical Association’s Current Procedural Terminology, or CPT, code set regarding:

• Correct modifier usage
• Evaluation and Management reporting guidelines
• National bundling edits

• National specialty societies, such as:

• American College of Surgeons
• American College of Radiology
• American Association of Neuromuscular and Electrodiagnostic Medicine
• American Cancer Society

As part of your contract with us, health care providers affiliated with the PPO network agree to supply services to Blue Cross members and bill according to guidelines and requirements set by the American Medical Association and select specialty societies.

If you have questions about the Blue Cross’ claim editing process, contact Provider Inquiry. Professional providers should call 1-800-344-8525, while facility providers should call 1-800-249-5103.