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 deductibte or coinsurance.

In the example below, it shows the remark/reject code of X5019. This indicates the services are applying to the member’s deductible. It also shows the ANSI code of PR, patient responsibility. In this example, the amount applied to the deductible may be billed to the member.