Quickly learn how to bill Blue Cross Blue Shield (BCBS) for mental health claims.

Blue Cross Blue Shield Association, often referred to as BCBS or BCBSA is an association of 33 independent locally operated companies that provide health insurance to over a hundred million people in the US. Because this is not one insurance company, the phone number to reach a rep will depend on which BCBS company you wish to speak to.

How to Bill Blue Cross Blue Shield

Once you have a copy of the client’s insurance card you should verify their eligibility and benefits directly with their Blue Cross Blue Shield Plan. Even if a client has a BCBS card, it doesn’t always mean their behavioral health benefits are administered by BCBS.

Because BCBS is several different entities, we recommend calling the number at the back of their insurance card. If there is no number available, call the local BCBS. Finally, if you are out of options you can call the Blue Card Program, which will direct you to the right plan. Blue Card Program’s phone number: 1-800-676-BLUE (2583).

Follow our benefits verification script to verify your paneling status with the client’s plan. Whether you are in-network or out of network you should always ensure you are getting the correct benefits quoted and obtain authorization if it is required.

Alternatively if you are a Blue Cross Blue Shield provider you can also use the online portal: Availity, although we still recommend calling.

Claims should be filed to the in-state plan where services were rendered, even if the client has a BCBS plan from a different state.

You can also have us at TheraThink handle it for you. We handle verification and claims with  Blue Cross Blue Shield  daily.

BCBS’ Claim Address: Where To Send BCBS Claims

You always should send BCBS claims to the local BCBS. Even if the client is from a different state or has a plan with a state across the country they should be filed to your local plan. You can look up your local Blue Cross Blue Shield office from the BCBS Website.

We recommend filing claims electronically but if that is not an option you can mail in the CMS 1500 form.

Multiple Brands Within The Same State

Some states have multiple brands of BCBS. For instance, Washington State has Premera and Regence. Others like California, Oregon, New York, Pennsylvania, and New Jersey also do. In these cases, you will want to directly ask the plan which address to file to.

What is BCBS’ Timely Filing Limit (TFL)?

The timely filing limit for BCBS depends on the plan. Standard claims usually have a 90 day timely filing limit after the date of service but this is not true 100% of the time. You can get the TFL on the benefits verification call.

Do I Need To Be In-Network In Order to Bill BCBS?

Not necessarily. This depends on the client’s insurance plan and your paneling status. BCBS PPO plans will still offer benefits for out of network providers.

We recommend calling and verifying the benefits to confirm the client’s plan and coverage.

How To Bill BCBS HMO Plans

You must be in the BCBS HMO network to see a client with an BCBS HMO plan. These plans do not offer out of network benefits.

How to Bill BCBS PPO Plans

BCBS Plans generally do have out of network benefits. Ask about these when you verify eligibility & benefits. Out of network benefits have higher deductibles and patient responsibility.

How To Bill BCBS Medicare Plans

BCBS offers several different Medicare advantage plans. Treat these exactly like other insurance plans. Call and verify the eligibility to confirm coverage and benefits.

How To Bill Out of State BCBS Plans (Blue Card Program)

Send the claims to your local BCBS. Through the Blue Card Program they will then be forwarded to the right place. If you send them directly to the out of state plan they will be denied!

How to Bill BCBS EAP

Some insurance plans will offer EAP (Employee Assistance Program) as a benefit administered. These plans require authorization and will only cover a set amount of visits. They do not require a co-pay. In these cases, you can bill the same as you would a routine visit, but add the EAP modifier code, HJ. Not sure if it is offered? Ask about EAP on the verification call.

After the EAP visits are exhausted, visits will fall under their normal behavioral health insurance benefits.

How to Bill BCBS Telehealth

The Telehealth modifier code varies depending on the BCBS company. The Modifier Code will usually be: 95. Sometimes it will be GT. The modifier code should be used on all Telehealth claims.

This is a Nightmare!

We can help you sort out these sorts of things without your input whatsoever.  Our expertise comes in handy daily when parsing out these carve out policies (in all states).  Learn how we can handle your mental health billing today.