Important coding reminder for Walk-in Retail Health Clinics

Some professional (837P/CMS-1500) claims for services rendered to non-Anthem/BlueCard Blue Cross and Blue Shield members at retail health locations are being reported with a place of service that does not reflect a retail health clinic location. Retail health clinics are small walk-in medical centers located inside retail outlets (e.g. pharmacies, grocery stores, etc.) where consumers can go to receive convenient and affordable basic primary care services. Specifically, for services rendered at a retail health location, some providers are submitting values for Office (11) or Urgent Care Facility (20) instead of the value of Walk-in Retail Health Clinic (17). Reporting place of service as 11 or 20 can cause claims to process incorrectly, and thus result in the need for claim adjustments and rework for providers.

 

If your practice is a Walk-in Retail Health Clinic, please remind your coding staff to report the most accurate place of service, Walk-in Retail Health Clinic (17), for professional claims when submitting claims for non-Anthem/BlueCard members.