This article is for acute care hospitals caring for our members
As a reminder, our existing Inpatient Acute Medical Admission payment policy applies to contracted providers rendering covered, medically necessary inpatient care.
You must follow the below important billing guidelines for outpatient and observation services preceding an inpatient admission, as currently outlined in our payment policy.
For hospitals that are |
Follow these billing guidelines |
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Reimbursed under APR-DRG methodology |
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Not reimbursed under APR-DRG methodology |
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Blue Cross reserves the right to perform post-payment review when services are not billed in accordance with our payment policies.
To view payment policies, log in and go to Office Resources>Policies and Guidelines>Payment Policies.
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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