Reminder: Itemized Bills
Reminder: Itemized Bills
Itemized bills are required for high dollar pre-payment (HDPR) reviews and should be submitted, when requested, via My Insurance Manager℠ (MIM) using the claims attachment feature. As a reminder, the dollar amount for HDPR reviews was reduced to $100,000.00 on Jan. 1, 2021.
Note: Medical records should not be submitted in lieu of itemized bills. If medical records are needed, a separate request will be sent to include instructions on how to submit. Please refrain from submitting unwarranted medical records.
When submitting itemized bills, be sure they are specific. Each line must have a clear description including doses, names of supplies and so forth. Also, be sure the revenue code and date of service for each line is present.
Example of an acceptable itemized bill:
| 42 Rev. Co. | 43 Description | 44 HCPCS/Rate/HPPS Code | 45 Serv. Date | 46 Serv. Units | 47 Total Charges |
| 0250 | Dicyclomine 10 MG | 010322 | 1 | 27.00 | |
| 0250 | Nitroglycerin 0.4 MG | 010322 | 1 | 28.73 | |
| 0250 | Midazolam 10 MG | J2250 | 010322 | 2 | 29.09 |
| 0250 | Atorvastatin 40 MG | 010322 | 2 | 76.93 | |
| 0272 | Catheter Angiographic | 010322 | 1 | 226.00 | |
| 0272 | Guidewire Vascular 3CM | C1769 | 010322 | 1 | 3597.00 |
| 0278 | Device Vascular Closure | C1760 | 010322 | 1 | 2563.00 |
Example of an unacceptable itemized bill:
| 42 Rev. Co. | 43 Description | 44 HCPCS/Rate/HPPS Code | 45 Serv. Date | 46 Serv. Units | 47 Total Charges |
| 0250 | Pharmacy | 336 | 7780.81 | ||
| 0272 | Sterile Supply | 8 | 7680.40 | ||
| 0278 | Supply/Implants | 2 | 6358.00 |
If you have any questions regarding this bulletin, please feel free to contact the provider education team at 803-264-4730 or Provider.Education@bcbssc.com.