Blue Shield of California has begun strictly enforcing its ancillary claims filing requirements for Blue plan member care provided by independent clinical labs, durable/home medical equipment providers and specialty pharmacies.
Generally, you should file Blue plan member claims with the local Blue plan. For these ancillary services, definitions for the local Blue plan are as follows:
- File claims from independent clinical labs with the Blue plan in the service area where the specimen was drawn based on the location of the referring provider.
- File claims from durable/home medical equipment (DME) and supply providers with the Blue plan in the service area to where the equipment was shipped or where it was purchased at a retail store.
- File claims from Specialty Pharmacy Providers with the Blue plan in the service area where the ordering physician is located.
If you have questions about these guidelines, call Blue Shield’s BlueCard® Claims Unit at (800) 622-0632.
Blue Shield of California will pay these ancillary claims according to your participation status with the local Blue plan as defined above, regardless of your participation with the Blue plan in your service area. Blue Shield will return all incorrectly filed claims to the provider with instructions to file with the appropriate local Blue plan, according to these requirements.