Please use the following guidelines for filing inpatient and outpatient claims:

• Inpatient claims with both covered and noncovered days:
  • When a claim has covered and noncovered days, facilities must report Value Code 80 (Covered Days) and Value Code 81 (Noncovered Days).
     
  • Value Code 31, Patient Liability Amount, should be used to report any charges for which the member is responsible. Room and board charges associated with a noncovered day should not be included in Value Code 31 without providing the member prior notice of the noncovered days.
     
  • It is appropriate to bill ancillary charges as outpatient claims when the days are noncovered. These outpatient claims should be submitted as covered charges on a Type of Bill, 12x.
• Outpatient claims should be filed using the appropriate physicians’ CPT/HCPCS code in the 2300 loop SV202 of the 837 claim transaction. 
• Inpatient claims should continue to be filed with the appropriate ICD-10 procedure codes. For electronic transmissions, use the correct ICD-10 procedure code in the 2400 loop HI01 of the 837 claim transaction. CPT/HCPCS codes are not required on inpatient claims and should not be filed for inpatient claims. 

Hospital Clinic Charges

Clinic Revenue Codes 510-529 are automatically noncovered by Blue Cross and Blue Shield of Alabama. This policy has been in effect since March 1992. It was determined that these codes are most commonly used to bill for physician visits at a hospital, making this charge part of the physician’s professional claim. It is not separately billable by the hospital. The patient is not responsible for these charges.

These revenue codes may be considered based on specific benefits on secondary contracts.

Note: FEP contracts are the exception for the coverage of these revenue codes.