This article is for acute care hospitals caring for our members
Blue Cross reimburses for emergency room services as outlined within our existing Emergency Room - Facility payment policy.
As a reminder, our payment policy states that Blue Cross:
- Reimburses emergency room services, which include:
- Room and facility charges that are directly related to the emergency, or
- Procedures performed in the emergency room, such as surgeries, treatments, and therapies.
- Separately reimburses ancillary services performed during an emergency room visit, such as laboratory and radiology work.
- Does not separately reimburse for services, products, or drugs considered incidental to the emergency procedure performed.
Payment policy application
Starting in Q1 2024, we will process claims pre-payment in accordance with our existing policy and will no longer separately reimburse services, products, or drugs considered incidental to the emergency room procedure performed. As a result, this will help reduce the number of claims that need post-payment review.
Resources
- Emergency Room - Facility payment policy
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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