This article is for all providers caring for our members
As you know, Blue Cross reimburses NOC (not otherwise classified) or unlisted CPT and HCPCs codes only when submitted with supporting documentation. In September 2024, we will clarify our General Coding and Billing payment policy regarding supporting documentation requirements. This update will allow for a more efficient, timely, and accurate review of claims billed with NOC codes.
For electronic claims, you may submit an appeal with supporting documentation. For paper claims, you may either submit the documentation with the claim itself, or in a separate appeal.
Payment policy application
Because unlisted codes do not describe a specific procedure or service, supporting documentation must contain clear, identifying information. This means that you should either circle or underline notes that identify the test or procedure associated with the unlisted code. The notes should be legible and contain the minimum necessary information to support the NOC code.
Note: We will only review clearly marked (circled,
underlined, etc.) notes.
You should already be following the guidelines below for NOC code supporting documentation. In September, we will include these criteria in our payment policy:
- A clear description of the type and extent of the procedure or service.
- Documentation should be specific to the procedure or service performed. Non-pertinent information should be omitted.
- Identify when the procedure was performed independently from other services provided, or if it was performed at the same surgical site or opening.
- Time, effort, and equipment necessary to provide the service, including any extenuating circumstances which may have complicated the service or procedure.
- The number of times the service was provided.
- When available, a similar or ‘treat-like’ code for the service represented by the NOC code.
- For drug NOC codes, NDC number is required.
If your supporting documentation does not adhere to these requirements, your claim’s processing will be impacted, with high potential for claim denial.
Resources
We will update our General Coding and Billing payment policy in September 2024 with these clarified guidelines.
To download our payment policies, log in and click Find a Payment Policy on the right side of your home page. Or, go to Office Resources>Policies & Guidelines>Payment Policies.
Questions?
If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.
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