Generally, as a health care provider you should file claims for your Blue Cross and Blue Shield patients to the local Blue Plan. However, there are unique circumstances when claims filing directions will differ based on the type of service rendered.
Claims submitted to Regence that are missing the point of pickup ZIP code or the air ambulance pickup is outside of our service area will be rejected.
How to file claims for ambulance services (required fields)
Point of Pickup ZIP Code:
- Populate the origin information (ZIP code of the point of pick-up), in the Ambulance Pick-Up Location Loop in the ASC X12N Health Care Claim (837) Professional.
- Populate the origin information (ZIP code of the point of pick-up) in the Value Information Segment in the ASC X12N Health Care Claim (837) Institutional.
File the claim to the Plan in whose service area the point of pickup ZIP code is located. If you contract with more than one Plan in a state for the same product type (i.e., Preferred Provider Organization or Participating), you may file the claim with either Plan.
- The point of pickup ZIP code is in the Regence service area.
- The claim must be filed to Regence, based on the point of pickup ZIP code.
Claims that are submitted to Regence incorrectly will be rejected. A message code will appear on the electronic remittance advice, indicating that you need to correct and resubmit the claim to the appropriate Blue Plan.
Exception: The updated guidelines do not apply to claims submitted for Federal Employee Program (FEP) members. You should continue to follow FEP claims filing guidelines.