October 8, 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
Referring Provider required on claims for Indian Health (Native American) Services effective January 1, 2014
Effective January 1, 2014 under the Patient Protection and Affordable Care Act (PPACA), insurers covering Native Americans who meet defined financial criteria are prohibited from applying cost sharing for items or services furnished directly by an Indian Health Service (IHS), an Indian Tribe, Tribal Organization or Urban Indian Organization or through a referral.
To administer benefits correctly for the Native American population, the treating provider must include the referring provider name and NPI when submitting a claim for services provided to an insured Native America beginning January 1, 2014 when these members present their paperwork to the provider.
The Referring Provider's name and NPI is submitted in Field Locator (FL) 78 of the UB-04 claim form. The electronic equivalent to FL 78 is 2310F (claim level) or 2420D (line level).If you have questions regarding this newsletter, please contact your Institutional Provider Representative. Denny Hartman can be reached at 1-316-269-1602; Cindy Garrison at 1-785-291-8862 and Janne Adams-Denton at 1-785-291-8813.