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INTRODUCTION  \nA. Our Statement of Purpose  \nB. Descriptions of Networks  \nC. Individual Product and Plan Options  \nD. Health Insurance Portability and Accountability Act of 1996  \nE. General Information  \nII. BLUECROSS BLUESHIELD OF TENNESSEE QUICK REFERENCE GUIDES  \nA. BCBST Telephone Quick Reference Guide  \nB. BCBST Contract Quick Reference Guide  \nC. Registering or Updating Your Provider Contract Address  \nIII. HOW TO IDENTIFY A BLUECROSS BLUESHIELD MEMBER  \nA. Identifying a Member’s ID Card  \nB. Determining Eligibility  \nC. Member Fees  \nIV. GROUP HEALTH CARE BENEFITS  \nA. Eligible Providers of Service  \nB. Additional Services  \nC. General Exclusions from Coverage  \nV. MEMBER POLICY  \nA. Introduction  \nB. Member Access-to-Care  \nC. Member Rights and Responsibilities  \nD. Member Grievance Process  \nE. Financial Responsibility for the Cost of Services  \nVI. BILLING AND REIMBURSEMENT  \nA. How to File a Claim  \n1. Filing Electronic Claims (Required Method)  \n2. Filing Paper Claims  \n3. Tips for Completing CMS-1500 and CMS-1450 Claim Forms  \n4. CMS-1500 Health Insurance Claim Form  \n5. Completing CMS-1500 Claim Form  \n6. Staff Supervision Requirements for Delegated Services  \n7. Locum Tenens Policy  \n8. CMS-1450 Facility Claim Form  \n9. Instructions for Returned Claims and Processed Claims Needing  \nCorrection  \n10. Coordination of Benefits  \n11. Maintenance of Benefits  \n12. Right of Reimbursement and Recovery (Subrogation)  \n13. Balance Billing  \n14. Provider Overpayment Recovery Policy/Process  \n15. Electronic Funds Transfer  \n16. Federal Employee Program (FEP) and Postal Service Health Benefits  \n(PSHB) Claims Filing Guidelines  \nBlueCross BlueShield of Tennessee Provider Administration Manual  \nB. General Billing and Reimbursement Guidelines  \n1. Medical Clinical Code Sets and Maintenance  \n2. Miscellaneous, Non-Specific and Not Otherwise Classified (NOC) Procedures/Services (Refer to “How to File a Claim” in this section for billing information)  \n3. Code Edits  \n4. Modifiers  \n5. Real Time Claim Adjudication  \n6. Qualitative Drug Screen Testing  \n7. Sexually Transmitted Infections Testing  \n8. Reimbursement Policy for Serious Reportable Adverse Events (Never  \nEvents)  \n9. Final Reimbursement  \n10. Policy for Quarterly Reimbursement Changes  \n11. Policy for Codes Priced on an Individual Consideration Basis  \nC. Professional Claim Billing and Reimbursement Guidelines  \n1. Lesser Of Calculation  \n2. Split Bills  \n3. Reimbursement Hierarchy for Professional and Home Health Services  \n4. Anesthesia Billing and Reimbursement Guidelines (Medicare lines of business will follow CMS guidelines)  \n5. Obstetric Anesthesia  \n6. Reimbursement Guidelines for Administration of Regional or General Anesthesia Provided by a Surgeon  \n7. Reimbursement Policy for Moderate Conscious Sedation  \n8. Guidelines for Resource Based Relative Value Scale (RBRVS) Reimbursement Methodology  \n9. Status Indicators  \n10. PC/TC Indicator – Global, Professional and Technical Components for Radiology, Lab and Other Diagnostic Procedures  \n11. Multiple Procedure Payment Policy Rule (MPPR) for Radiology  \n12. BCBST Laboratory Testing Code Reimbursement Policy  \n13. Global Days – Reimbursement Guidelines for Global Periods  \n14. Preoperative, Intraoperative, and Postoperative – Reimbursement Guidelines for Preoperative Management Only, Surgical Care Only, and Postoperative Management Only Services (Modifiers 54, 55 56)  \n15. Discontinued and Reduced Services/Procedures (Modifiers 52, 53, 73,74)  \n16. Reimbursement Guidelines for Multiple Procedures Using Modifier 51 (Medicare lines of business will follow CMS guidelines)  \n17. Reimbursement Guidelines for Bilateral Procedures  \n18. Assistant-at-Surgery (Modifiers 80, 81, 82, AS)  \n19. Reimbursement Guidelines for Procedures Performed by Two Surgeons (Modifier 62)  \n20. Reimbursement Guidelines for Screening Test for Visual Acuity  \n21. Reim","cbCais5jNAJRYuvR","https://ap.wps.com/l/cbCais5jNAJRYuvR","pdf",4393176,387,"English","# I. INTRODUCTION\n## A. Our Statement of Purpose\n## B. Descriptions of Networks\n## C. Individual Product and Plan Options\n## D. Health Insurance Portability and Accountability Act of 1996\n## E. General Information\n# II. BLUECROSS BLUESHIELD OF TENNESSEE QUICK REFERENCE GUIDES\n## A. BCBST Telephone Quick Reference Guide\n## B. BCBST Contract Quick Reference Guide\n## C. Registering or Updating Your Provider Contract Address\n# III. HOW TO IDENTIFY A BLUECROSS BLUESHIELD MEMBER\n## A. Identifying a Member’s ID Card\n## B. Determining Eligibility\n## C. Member Fees\n# IV. GROUP HEALTH CARE BENEFITS\n## A. Eligible Providers of Service\n## B. Additional Services\n## C. General Exclusions from Coverage\n# V. MEMBER POLICY\n## A. Introduction\n## B. Member Access-to-Care\n## C. Member Rights and Responsibilities\n## D. Member Grievance Process\n## E. Financial Responsibility for the Cost of Services\n# VI. BILLING AND REIMBURSEMENT\n## A. How to File a Claim\n## B. General Billing and Reimbursement Guidelines\n## C. Professional Claim Billing and Reimbursement Guidelines","[{\"question\":\"What steps does the manual provide for filing a claim with BCBST?\",\"answer\":\"It outlines how to file a claim, including required electronic claims, paper claims, and practical tips for completing CMS-1500 and CMS-1450 claim forms, along with guidance for returned or corrected claims.\"},{\"question\":\"How does the manual describe provider reimbursement rules for coding and claim processing?\",\"answer\":\"It covers medical code sets and maintenance, code edits, modifiers, real-time claim adjudication, status indicators, and detailed reimbursement policies for various services and billing scenarios.\"},{\"question\":\"What does the manual say about identifying members and determining eligibility?\",\"answer\":\"It explains how to identify a member’s ID card, determine eligibility, and understand member fees as part of how providers verify and manage coverage.\"}]","BlueCross BlueShield of Tennessee Provider Administration Manual | PDF",1789979458,975]