Reminder: Itemized Bills

April 21, 2022

Itemized bills are required for high dollar pre-payment (HDPR) reviews and should be submitted, when requested, via My Insurance Manager℠ (MIM) using the claims attachment feature. As a reminder, the dollar amount for HDPR reviews was reduced to $100,000.00 on Jan. 1, 2021.

Note: Medical records should not be submitted in lieu of itemized bills. If medical records are needed, a separate request will be sent to include instructions on how to submit. Please refrain from submitting unwarranted medical records.

When submitting itemized bills, be sure they are specific. Each line must have a clear description including doses, names of supplies and so forth. Also, be sure the revenue code and date of service for each line is present.

Example of an acceptable itemized bill:

42 Rev. Co. 43 Description 44 HCPCS/Rate/HPPS Code 45 Serv. Date 46 Serv. Units 47 Total Charges
0250 Dicyclomine 10 MG   010322 1 27.00
0250 Nitroglycerin 0.4 MG   010322 1 28.73
0250 Midazolam 10 MG J2250 010322 2 29.09
0250 Atorvastatin 40 MG   010322 2 76.93
0272 Catheter Angiographic   010322 1 226.00
0272 Guidewire Vascular 3CM C1769 010322 1 3597.00
0278 Device Vascular Closure C1760 010322 1 2563.00

Example of an unacceptable itemized bill:

42 Rev. Co. 43 Description 44 HCPCS/Rate/HPPS Code 45 Serv. Date 46 Serv. Units 47 Total Charges
0250 Pharmacy     336 7780.81
0272 Sterile Supply     8 7680.40
0278 Supply/Implants     2 6358.00

 

If you have any questions regarding this bulletin, please feel free to contact the provider education team at 803-264-4730 or Provider.Education@bcbssc.com

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