Blue Cross Newsletter

July 23, 2010



To: All Blue Cross Contracting Providers

Cindy Garrison, CPC – Education/Communication Coordinator
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association


Medicare Advantage Billing Reminder

This notification is a reminder that Blue Cross and Blue Shield of Kansas (BCBSKS) needs to receive certain data elements in order to adjudicate Medicare Advantage claims accurately and timely.  Please note that you may already be submitting these data elements, as appropriate, on Medicare Advantage claims. 

How do you identify a Medicare Advantage member?

Medicare Advantage members have distinctive product logos on their medical ID card to help you recognize them.  All logos have Medicare Advantage in the design – see the examples below.
Medicare Advantage HMO                     MA PPO Medicare Advantage                              Medicare Advantage PPO

Medicare Advantage POS                  Medicare Advantage PFFS           Medicare Advantage MSA

Why are we reminding you about provider billing?

Most providers supply all the information we require to adjudicate claims.  However, some providers miss certain critical data elements that are needed to process Medicare Advantage claims.

Providers treating Medicare Advantage members must ensure that they send in clean claims with all necessary data to BCBSKS according to the Medicare Managed Care Manual.

The data elements identified below need to be included on Medicare Advantage claims sent to BCBSKS to ensure that claims will be paid accurately and timely. The Centers for Medicare & Medicaid Services (CMS) already requires providers to bill with these elements for traditional Medicare.

Providers must include the following data elements on Medicare Advantage claims, when applicable:

Data Element


Service Location ZIP Code (if different than Billing Provider ZIP Code)

If services occur at primary location:
Form Locator 01
Line 3 Positions 17-25
If services occur at a secondary location:
Not Applicable

Source of Referral for Admission (for Home Health Claims) (One alpha-numeric character indicating transfer or admission)

Form Locator 15 Point of Origin for Admission or Visit

Height and Weight for ESRD Patients

Form Locators 39-41 Value Codes and Amounts

Core Based Statistical Area (for Home Health and ESRD claims)

Form Locators 39-41 Value Codes and Amounts

Ambulance Pick-Up Zip Code

Form Locators 39-41 Value Codes and Amounts

HIPPS Code for Home Health, Skilled Nursing and Inpatient Rehabilitation

Form Locator 44 HCPCPS/Accommodation Rates/HIPPS Rate Codes

National Provider Identifier

Form Locator 56

Treatment Authorization Code (for Home Health Claims)

Form Locator 63 Treatment Authorization Code

Admitting Diagnosis Code

Form Locator 69 Admitting Diagnosis Code

Present On Admission (POA) Indicator

Form Locator 67 Principal Diagnosis Code and Present on Admission Indicator
Form Locator 67A-Q Other Diagnosis Codes and Present on Admission Indicator
Form Locator 72a-c External Cause of Injury (ECI) Code and Present on Admission Indicator
Position 8 (for all)

Taxonomy Code (if you represent an institution with more than one subpart to bill)

Form Locator 81 Code-Code Field
Left Column =B3
Middle Column = Taxonomy Code

 What happens if you don’t include these data elements, as appropriate, on claims?

Failing to provide the necessary data elements on a claim, when applicable, may delay payment of the claim.  We may have to call you to verify the data or return the claim to you.

Where do you submit the claim?

You should submit the claim to BCBSKS under your current billing practices. Do not bill Medicare directly for any services rendered to a Medicare Advantage member.

Who do you contact if you have a question about the data elements?

If you have any questions regarding the Medicare Advantage program or products, please contact your provider consultant.