Blue Cross Newsletter

December 30, 2010



To: All Blue Cross Contracting Providers
From: 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
Subject: Limited Patient Waiver

Blue Cross and Blue Shield of Kansas (BCBSKS) has defined Limited Patient Waiver to mean:

A form that a contracting provider must have the member sign prior to rendering services in order to transfer financial responsibility to the
member for certain services not covered by a payer - commonly because
the services are not medically necessary, experimental or investigational, patient demanded, or considered deluxe features.

As a result of this definition, Blue Cross will transition the Notice of Personal Financial Obligation (NOPFO) waiver to the Limited Patient Waiver (LPW) during 2011.  You can start using this new form immediately or you can continue to use the NOPFO through 2011.  Both waivers will be on the Web site at through 2011.  You will need to scroll down on the Web page to the forms under INSTITUTIONAL and select the waiver you want to use.

As a reminder, contracting providers shall notify BCBSKS members when services are determined medically unnecessary or experimental/investigational.  Providers cannot bill the member for these services unless the member has been given written notification in advance of receiving the service that they will be responsible. 

If you obtain a waiver you do not need to drop the claim to paper.  You can still file the claim electronically by appending modifier GA to the applicable CPT/HCPCS code(s).  Modifiers should immediately follow the procedure code, with no space between.  By obtaining a signed waiver, the charges will be denied as the patient’s responsibility.  If a waiver is not obtained, the services will be a provider write-off. 

Remember to retain the waiver in the patient's file.