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Government Programs: Hospice Revenue Codes and Authorization Requirements

Posted June 5, 2018

Blue Cross and Blue Shield of Illinois (BCBSIL) is providing guidance on our requirements for hospice care. Different portions of hospice care are covered by different entities based on the member’s benefit coverage. Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Community Health PlansSM (BCCHPSM) MLTSS members receiving hospice care, including hospice drugs, should obtain hospice authorization and submit claims for the Medicare portion of the hospice care to the Centers for Medicare & Medicaid Services (CMS). Hospice providers are required to coordinate these services with the rest of the member’s care. BCBSIL will remain the payer for Medicare Part D non-hospice covered drugs.

The Medicaid component of the hospice care remains with BCBSIL, the managed care organization (MCO). Therefore, BCBSIL will process the Medicaid portion of the claims according to Medicaid rates listed on the Healthcare and Family Services (HFS) fee schedule. Providers are still required to submit the Notice of Election form to HFS.

If the rates applied to the claim differ from the HFS fee schedule, please contact our Claims Department at 877-723-7702 (MMAI) or 877-860-2837 (BCCHP/MLTSS) or your Provider Network Consultant (PNC) for assistance. 

Revenue Code

Authorization and Claim Submission

658

  • Authorization NOT required for all lines of business
  • Submit claims to BCBSIL

651, 652, 655 and 656

BCCHP (not MLTSS members)

  • Authorization is required
  • Submit claims to BCBSIL

MMAI and BCCHP (MLTSS members)

Submit claims and authorization requests to CMS