Migrated Claims – Deductible & Coinsurance

Blue Cross Blue Shield of North Dakota (BCBSND) is providing clarification regarding the use of rejection codes for services that apply to deductible and coinsurance. In the new HMHS claims processing platform, what may appear to be a rejected claim could in fact just be an indication of cost-sharing. A rejection code is used to indicate a service applies to the member’s deductible or coinsurance.

An example of this would be the use of the claim adjustment group code of PR (patient responsibility) with a claim adjustment reason code of 1 (deductible amount).