OSP News

Claims Submission and Processing Guidelines for Referring Providers

Posted: 09/13/2024

Claims for referring physicians must be submitted with a valid provider type and unique NPI. The referring provider must be an M.D., D.O., physician assistant, nurse practitioner or certified nurse-midwife. The rendering and referring provider cannot have the same NPI. If any of these data elements are missing or invalid, the claim will be denied. 

For more details on claims submission and processing, refer to the Section 2.3 of the Medicaid Provider Manual* and Section 13 of the Blue Cross Complete Provider Manual at mibluecrosscomplete.com

If you have additional questions, contact your Blue Cross Complete provider account executive or the Blue Cross Complete Provider Inquiry at 1-888-312-5713.

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