Notification on Medicare Mass Adjustments for 2019 dates of service

Blue Cross Blue Shield of North Dakota (BCBSND) would like to provide guidance to providers who were impacted by the Medicare mass adjustment for 2019 claims when outpatient clinic visits (HCPCS code G0463) were provided at off-campus provider-based departments.

Medicare mass adjustments do not cross over automatically to BCBSND. Because of this, secondary claim corrections need to be manually submitted by providers.

To assist in accurately processing claims BCBSND is asking providers who were impacted by this change to submit a new frequency 1 claim with the correct other party liability (OPL) information.

BCBSND will capture these claims and do a manual review against prior submitted claims to ensure the correct payment is made. Timely filing does not apply to these claims because they are secondary payer claims.

We ask that you do not submit a frequency 7 adjustment request for this scenario. This applies to BCBSND and FEP members. For claims filed directly to another plan for a non BCBSBND member, contact the member’s plan directly for information.

For any questions regarding this process please contact Provider Services at 1-800-368-2312.

Information regarding the 2019 payment for Outpatient Clinic Visit Services at Excepted Off-Campus Provider-Based Departments can be found Centers for Medicare and Medicaid Services’ (CMS) MLN Connects, dated January 14, 2021.