April 2, 2013
All Blue Cross and Blue Shield of Kansas Contracting ProvidersFrom:
Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association
BCBSKS Claims Filing for Independent Clinical Laboratory (Lab)
As a healthcare provider, claims should generally be filed to Blue Cross and Blue Shield of Kansas (BCBSKS) for your Blue Cross and Blue Shield patients. If a provider contracts with more than one Blue Plan for the same product type (e.g. PPO or Traditional), you may file the other Blue Plan patient’s claim with either Plan. However, there are unique circumstances when claims filing directions will differ based on the type of provider, such as an out-of-state Independent Clinical Laboratory.
An Independent Clinical Laboratory is any type of non-hospital based laboratory. The types of services that an Independent Clinical Lab may perform include (but are not limited to) blood, urine, and sample analysis.
Determining where the lab service should be filed is based on where the specimen was drawn. The facility should bill BCBSKS for the draw/technical component and the out-of-state independent clinical lab should bill directly to BCBSKS for their component.
If the out-of-state independent clinical lab is not contracting directly with BCBSKS, then the patient’s claim is processed applying the patient’s out-of-network benefits and the patient will be responsible for additional out-of-pocket expenses. BCBSKS recommends that our contracting facilities verify that the lab is directly contracting with BCBSKS for specimens sent to an out-of-state lab. This will ensure that your patient/our member is not adversely affected. A list of in-network participating providers may be obtained via the Web at http://www.bcbsks.com/ProviderDirectory/BCBSKS encourages our contracting providers to verify BCBSKS Member Eligibility and Benefits by logging on to www.Availity.com or call Customer Service prior to providing any service.
If you have questions regarding this newsletter, please contact your BCBSKS Provider Representative.