Claim Submission Reminders

Bilateral billing and claim corrections

The following information is a claim submission reminder for professional outpatient services. Blue Cross Blue Shield of North Dakota (BCBSND) is seeing an increase in duplicate rejections when providers submit a new claim rather than submitting a claim correction (Frequency Type 7) to the original.

Frequency Type 7 is a replacement of a prior claim and is used to correct data reported incorrectly on the original claim. The original claim number assigned by BCBSND is required on this type of submission.

Examples of when a claim correction (Frequency Type 7) is appropriate:

  • Add or remove charges
  • Adding or removing a modifier
  • Changes to diagnosis code
  • Correcting date of service
  • Changing billed amount

For more information on the claim corrections process (Frequency Type 7), refer to the provider manual located on the BCBSND provider page of our website:
https://www.bcbsnd.com/content/dam/bcbsnd/documents/manuals/provider-manual-full.pdf.

Claim corrections reduce cost and time on accounts receivable follow-up and the cost of claim submission.

Outpatient Other Carrier Payment Information

Blue Cross Blue Shield of North Dakota (BCBSND) has noticed an increase in the amount of claim corrections relating to other carrier payment information not processing correctly when BCBSND is secondary. Specifically, these requests are due to incorrect payment/processing when patient liability other than deductible, coinsurance or copay are remaining from the primary carrier (i.e. PR96 or PR204).

In order to ensure accuracy in processing, all outpatient claims need to have the primary insurance carrier (commercial or Medicare) payments at line level. If outpatient claims with other primary insurance payments, including Medicare, are not submitted with the CAS/ANSI information at the line level, the claim can process and pay incorrectly. For claims that are processed incorrectly due to the payment information only being submitted at claim level, adjustment requests can be made by phone if it is clear which line the denial applied to. If the denied line is not clear (i.e. denied amount does not match a line charge), a claim correction must be submitted with the CAS/ANSI information at the line level.