Claim Form Rule: Adding or Removing Facility Blue Shield Provider Number

What claim change is needed?

Depending upon Blue Shield's requirement, the Blue Shield Provider ID may or may not be required on the CMS-1500 claim.  This claim form rule with either add, remove, or/and write to claim if this ID is present. Please note, that this rule can also be used to add a Medicaid ID as well. 

Box Number

UB-04: n/a

CMS-1500: Box 32b - Other ID#

Steps

1. Navigate to Management Center > Claim Rules
2. Click "Create Claim Form Rule".
3. Select the Practice.
   
4. Name the claim rule.
   
   Set Claim Type to Institutional depending upon service.
     
5. Set conditions for the claim rule to be met.
6. Select the Available Behavior: Facility - Blue Shield Provider Number.
   
7. Then click Add.
8. Depending upon the situation, from the Select dropdown arrow - Omit, Require and Write to Claim, or Write to Claim if Present.
   
9. At the bottom of the window, click the Create button.

Related Articles

Manage Facilities

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.