Add or Remove the Blue Shield Provider Number

This rule is used to add or remove the payer-assigned Other ID also known as the Blue Shield Provider Number. This rule is most commonly used for Blue Shield and Medicaid claims.

Note: This rule will add information to box 32b on the CMS-1500 and can conflict with this rule as well as this rule that adds the facility location number to the same box. To learn more about claim rule ordering, click here.

Workflow

Let's review how to create a claim rule to add or remove Blue Shield Provider Number!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create Claim Claim Form Rule.
     
  3. Select the Practice.
     
  4. Next, give the rule a name.
  5. Update the Claim Type to Professional.
     
  6. Select Conditions to create criteria a claim should meet before the rule will apply.
     
  7. Next, click on the Behaviors dropdown.
  8. Select Facility - Blue Shield Provider Number.
     
  9. Next, click Add.
     
  10. Update the dropdown to one of the following:
      1. Omit to create the claim without the other ID.
      2. Require and Write to Claim to require the other ID be included in the claim.
      3. Write to Claim If Present to instruct the system to only include the other ID when present within the facility profile. 
         
  11. To create multiple behaviors, repeat steps 7-10.
  12. Click Save to complete the process.
       

Box Number(s)

• UB-04: N/A
• CMS-1500: Box 32b - Other ID#

Helpful Hints

• If one of your conditions is payer-based, select Current Sequence Behavioral instead of the Primary Behavioral Payer. This will ensure the rule applies to secondary and tertiary claims when needed. 
• To read more about how to set claim rule conditions and order, see the Claim Rule: Setting Claim Rule Conditions article.
• To read more about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article.