CommercialApril 25, 2024
Instructions for donor claim billing
Use the information below to help complete required patient information on donor claims. Correct completion of the form is needed to process the claim.
Donor claims
There are two patients involved in an organ donation — the donor and the recipient. The insurance plan for the recipient is responsible for paying the donor claim. The recipient can be the subscriber or a dependent to the subscriber (Note: Plans are instructed to include living donor charges on the recipient claims).
When billing for services rendered to the transplant donor, the care provider enters the recipient’s name, date of birth, sex, and Anthem ID number.
Completing forms
Review the information outlined below for billing instructions needed to process donor claims.
CMS-1450 (UB-04 Uniform Bill):
- UB box 8b — recipient’s name*
- UB box 10 — recipient’s birthdate
- UB box 11 — recipient’s sex
- UB box 42 — donor ICD-10-CM codes and revenue codes
- UB box 58 — subscriber’s name
- UB box 59 — relationship code of 39 or 40
- UB box 60 — subscriber ID number
- UB box 66 — donor diagnosis codes
- UB box 80 — note this is a donor claim submission with donor’s name
CMS-1500 (Health Insurance Claim Form):
- HCFA box 1a — subscriber’s ID number
- HCFA box 2 — recipient’s name*
- HCFA box 3 — recipient’s date of birth and gender
- HCFA box 4 — subscriber’s name
- HCFA box 6 — relationship to subscriber, other (Complete with 39 or 40.)
- HCFA box 19 — note, this is a donor claim submission with donor’s name
- HCFA box 21 — donor diagnosis code
- HCFA box 53 (electronic claim) — will list the donor’s name:
- Example: Claim note ref code: ADD Claim note Text: 39-Jones, Sally
* The recommendation is that the recipient’s name be billed. However, the care provider can bill with the donor’s name. If the claim is billed with the recipient’s name, it has a better chance at adjudication upon initial submission.
We are focused on reducing administrative burdens, so you can do what you do best — care for our members.
Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CM-056555-24-CPN54528
PUBLICATIONS: May 2024 Provider Newsletter
To view this article online:
Visit https://providernews.anthem.com/ohio/articles/instructions-for-donor-claim-billing-19405
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