Claims & Best Practices

Advanced Claims Editing 

We are sharing coding advice to help Providers prepare for our automated claims review process starting March of 2023. These ongoing tips help ensure your claims are properly coded.

Coding Advice 

BCBSWY will deny professional claims for diagnostic tests or radiology services billed with modifier -TC in the inpatient or outpatient facility setting. The technical component of these services should be billed by the facility in these settings. 

BCBSWY will deny professional component only procedures when billed with modifier -TC. For example, billing procedure 93010 (Routine ECG, interpretation and report) with modifier -TC. Professional component only procedures are payable in any place of service. It is inappropriate to bill these procedure codes with a -TC modifier as it is not applicable to this group of procedure codes. 

Best Practices 

BCBSWY would like to remind Providers of these best practices to save time with claims submissions. 

Hearing Aid Invoice

Please provide an invoice when billing for hearing aids.

Prior Authorizations

BCBSWY requires prior authorizations, both for in-patient stays and services, submitted through the Availity portal. See the original update here:

Annual Wellness

BCBSWY encourages Primary Care Providers to remind your patients to schedule an annual wellness visit. Annual exams are essential. We know that regular preventive care is one of the best ways to identify and treat health issues before they get worse. Click here to see the complete list of preventive benefits that BCBSWY covers. 


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