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Becoming an Electronic Submitter | EDI Manuals | Provider ID Numbers & Payer Codes | Hints for Successful Submission | Frequently Asked Questions | Contact Information
The following provides information to assist with effective electronic claim submission to us. Our processing systems require specific adjudication rules for certain types of claims. The information below includes these adjudication rules and other helpful information for Maryland and National Capital Area (NCA) products.
Electronic Inhibitors
Listed below are types of claims that we suggest not be submitted electronically,
as additional infomration may be required to expedite processing.
- MD and NCA Institutional- Coordination of benefits claims
- MD Institutional-
- Psychiatric halfway house claims
- Rehabilitation facility claims
- NCA Professional- Coordination of benefits claims
- MD Professional-
- Coordination of benefits claims
- Claims reporting modifiers 21, 22, 62, 66 & 78
Do not electronically submit claims requiring attachments
We suggest that claims requiring attachments not be submitted electronically. Please see the chart below to see what attachments are required for which area.
| Professional and Institutional
Claims |
Required Attachments |
Maryland |
NCA |
| Coordination of benefits |
Other carrier EOB statements |
YES |
YES |
| Subrogation |
Letters to determine if coordination is required |
YES |
Upon Request |
| Professional Claims |
Required Attachments |
Maryland |
NCA |
| Those billed with modifiers 21, 22, 62, 66 & 78 |
Doctor's notes, doctor's orders, sleep study reports, etc. |
YES |
Submit required notes electronically |
| Specialized surgery or complicated procedure |
Medical necessity statement, itemized bills, operative notes or other
additional information |
YES |
Upon Request |
| Institutional Claims |
Required Attachments |
Maryland |
NCA |
| Ambulatory Surgery Center claims billed with Revenue code 270 (surgical
supplies) |
Surgical supply invoice |
YES |
NO |
Disclaimer: Accepting claims for certain services does not guarantee payment. You must verify member eligibility and benefits prior to rendering services.
Professional and Institutional Services Accepted Electronically for Maryland and NCA Indemnity, Federal Employee Program and National Accounts (NASCO*)
| Professional and Institutional
Services |
Professional Electronic |
Institutional Electronic |
| Surgery (Including oral) |
YES |
YES |
| ASC (Except when billing revenue code 270) |
YES |
YES |
| Litho |
YES |
YES |
| ESRD (Freestanding) |
YES |
YES |
| Donor Surgery |
YES |
YES |
| Physician Assistant at Surgery |
YES |
YES |
| Elective Abortion |
YES |
YES |
| Maternity |
YES |
YES |
| Birthing Center |
YES |
YES |
| Anesthesia |
YES |
YES |
| Emergency Medical Care (Including accident) |
YES |
YES |
| Pre-Admission Testing |
YES |
YES |
| Professional Component |
YES |
N/A |
| Diagnostic Radiation, Nuc. Med. & Ultrasound |
YES |
YES |
| Concurrent Care |
YES |
N/A |
| Well Baby Care/Visit |
YES |
YES |
| Diagnostic Machine Test |
YES |
YES |
| Psychiatric Care |
YES |
YES |
| Second Opinion Program |
YES |
N/A |
| Alcohol Rehabilitation |
YES |
YES |
| Consultations |
YES |
YES |
| Drug Rehabilitation |
YES |
YES |
| Medical Care - inpatient and outpatient medical |
YES |
YES |
| Chemotherapy |
YES |
YES |
| Physical Therapy |
YES |
YES |
| Radiation Therapy |
YES |
YES |
| Occupational Therapy |
YES |
YES |
| Speech Therapy |
YES |
YES |
| Respiratory Therapy |
YES |
YES |
| Therapeutic Services |
YES |
YES |
| Diagnostic Path/Lab |
YES |
YES |
| Whole Blood |
N/A |
YES |
| Hospice Care |
N/A |
YES |
| Ambulance |
YES |
YES |
| Phys. Access.- Purchase (ortho/prosthetic) |
YES |
YES |
| Phys. Access.- Rental (ortho/prosthetic) |
YES |
YES |
| DME |
YES |
YES |
| Pharmacy (vendor processing) |
N/A |
N/A |
| Routine Vision Care (examination only) |
YES |
N/A |
| Home Health Care Service |
YES |
YES |
| Visiting Nurse Services |
YES |
YES |
| Private Duty Nursing |
YES |
YES |
| Skilled Nursing Facilities |
YES |
YES |
| Hearing Care |
YES |
YES |
| Medicare Submitted Secondary Claims |
YES |
YES |
*NASCO - National Accounts Service and Claims Operations
Note = Notes are accepted on electronic institutional claims
N/A = type of service is not billed on the type of claim
YES = Service is allowed to be billed electronically for that type of claim
NO = Service should not be billed electronically for that type of claim
More helpful hints:
- Check your Uniform Claims Receipt Report (UCRR) daily to make sure no claims were returned with errors.
- Correct claims with errors and resubmit promptly to avoid filing issues.
- Make sure you are enrolled separately to submit claims for Maryland vs. NCA products.
- Include the patient's entire membership number, including the prefix.
- Include your entire provider ID number.
- Use standard data code sets (e.g., HCPCS, ICD-9, CPT®.)
- Include date of onset for all applicable codes.
- Include accident and/or symptom indicator for all applicable codes.
- Include all referral information on CareFirst BlueChoice claims submitted by a specialist.
- Include the patient relationship code on all claims.
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