Blue Cross Blue Shield of North Dakota (BCBSND) wants to inform providers of claims filing rules when collaborating with an out-of-state provider to perform services.
BCBSND has been receiving claims directly from non-North Dakota provider(s) who performed a professional component service (modifier 26) in another state’s brick-and-mortar location. In this scenario, a North Dakota provider is performing the technical component of the service, and an out-of-state provider is assisting with the professional component.
Providers who collaborate electronically on member care, and do so from separate, brick-and-mortar locations, must file claims to the local Blue Cross Blue Shield plan based on where the provider is located.
An example of this is when a North Dakota provider takes a radiologic image in a North Dakota clinic, then sends the image to a non-contiguous county provider in another state to determine the results; for this example, we will use Minnesota.
The claims should be filed this way:
- The North Dakota provider who took the image files the claim directly to BCBSND
- The Minnesota provider who received the request to read/analyze the image files directly to BCBSMN
The above would not fall under the snowbird/temporarily out-of-area or out-of-area virtual support providers guidelines. A description of these two scenarios can be found below:
- Snowbird/temporarily out-of-area providers: Providers that are temporarily outside their original service area can continue to service their patients virtually for up to six months within a 12-month period. These claims are filed to the providers’ original local plan.
- Out-of-area virtual support providers: Providers that reside in one service area (BCBSTX) and are employed by a brick-and-mortar provider group/facility located in another service area (BCBSND) to render virtual services to their members must file claims to their local plan (BCBSND). Contracting is limited to the local provider group/facility. Plans may not contract directly with out-of-area providers.
- For example, if a provider works out of his home in Texas but is employed by a contracted BCBSND provider, and performs virtual support services, these claims should be filed to BCBSND, since the provider is employed by a provider whose brick-and-mortar is located in North Dakota.
Questions?
If a provider has a question on where to file a claim, they should contact their local BCBS.
