Posted July 15, 2021
In December 2020, Blue Cross and Blue Shield of Illinois (BCBSIL) received updated guidance from the Illinois Department of Healthcare and Family Services (HFS) on pricing reimbursements for manually priced DME devices (items not listing an established reimbursement rate on the fee schedule) for non-reusable and reusable, wheelchair and wheelchair accessories as outlined by Illinois General Assembly via the Joint Committee on Administrative Rules (JCAR). This guidance replaced the manual pricing reimbursement methodology previously posted in June 2018.
Based on this new guidance, as of Dec. 11, 2020, the Blue Cross Community Health PlansSM (BCCHP) claims system requires a pricing invoice or provider price list for any manually priced item.
The pricing invoice should contain the following data:
- Member name
- Date of service
- Item name/description/Healthcare Common Procedure Coding System (HCPCS) code
- Number of units provided
- Item wholesale price/manufacturer suggested retail price (MSRP)
Claims received with a manually priced item listed not accompanied with an appropriate pricing invoice will result in denial with reason code heh (resubmit with required invoice).