Common use of Billing Requirements Clause in Contracts

Billing Requirements. i. All services must be billed in accordance with applicable Medicare billing guidelines issued by CMS. ii. All services must be billed on a UB04 or CMS-1500 or successor claim form, as applicable, consistent with CMS implementation date and Medicare billing guidelines. iii. Blue Cross and Blue Shield of North Carolina will update DRG, ICD-10 diagnosis, ICD- 10 procedure, revenue, CPT, and HCPCS codes and code categorizations as new codes are created, without requiring amendment to this Agreement. Updates by CMS will be implemented no later than 30 days from their effective date with CMS, and will not result in claims reprocessing. iv. Hospital billed CRNA services shall be filed on a CMS-1500 or successor claim form according to Medicare billing guidelines with the appropriate modifier(s), and reimbursement will be based on the Medicare CRNA fee schedule. v. Blue Cross and Blue Shield of North Carolina will recognize and reimburse Level II HCPCS codes that have replaced Level I CPT codes by OPPS.

Billing Requirements. i. All services must be billed in accordance with applicable Medicare billing guidelines issued by CMS. ii. All services must be billed on a UB04 or CMS-1500 or successor claim form, as applicable, consistent with CMS implementation date and Medicare billing guidelines. iii. Blue Cross and Blue Shield of North Carolina will update DRG, ICD-10 diagnosis, ICD- 10 procedure, revenue, CPT, and HCPCS codes and code categorizations as new codes are created, without requiring amendment to this Agreement. Updates by CMS will be implemented no later than 30 days from their effective date with CMS, and will not result in claims reprocessing. iv. Hospital billed CRNA services shall be filed on a CMS-1500 or successor claim form according to Medicare billing guidelines with the appropriate modifier(s), and reimbursement will be based on the Medicare CRNA fee schedule. v. Blue Cross and Blue Shield of North Carolina will recognize and reimburse Level II HCPCS codes that have replaced Level I CPT codes by OPPS.