April 25, 2014
All Blue Cross 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
Value Code Required for Private Room Only Facilities
Value Codes and amounts (FL 39-41 on the UB-04 claim form) are defined as a code structure to relate amounts or values to identify data elements necessary to process the claim as qualified by the payer organization. The value code is required on a UB-04 claim form when there is a value code that applies to the claim. Effective April 13, 2014, contracting facilities with only private rooms are required to submit claims with a value code of 02 (hospital has no semi-private rooms) and a room rate amount of 0.00 in Field Locator 39-41.
The submission of Value code 02 will assist in the processing of BlueCard claims for services provided to an out-of-state Blue Plan member. When a facility only has private rooms, the average semi-private (AVSP) room rate is not applicable.
If you have questions regarding this newsletter, please contact your Institutional Provider Representative. Denny Hartman can be reached at 1-316-269-1602 and Cindy Garrison at 1-785-291-8862.