Description:
Blue Cross and Blue Shield reserves the right to accept or not to accept assignment of benefits.  

Benefits are paid directly to providers who contract with us as a preferred provider or who participate in other network arrangements.  Patients who use non-network providers may be paid directly in most instances.

Policy:
When Blue Cross and Blue Shield agrees to pay benefits to a non-contracting provider, the following requirements must be met.

Requirements For Accepting Assignment
To accept assignment, the provider must:

Obtain the signature of authorization from the member in the appropriate block on the claim form (HCFA  1500 or other claim forms).  "Signature on file" or authorization from the member on a separate sheet of paper attached to the claim form is acceptable.

Check "Yes" in the appropriate block of the HCFA 1500 form indicating the provider accepts assignment or attach a separate sheet to the claim for stating assignment accepted.  "Benefits assigned" or "Accepts assignment" stamped on the HCFA 1500 form is acceptable.

If a claim has been completed as assigned but the total charge has been paid in full (no balance due), the assignment will be voided and benefits will be assigned to the member.

Superbills attached to the HCFA 1500 form or other claim form are acceptable when the member has authorized payment to the provider.

Requirements For Non-Assigned Claims
Check no in the appropriate block on the claim form indicating the provider does not agree to accept assignment.

• If claim has been paid in full, benefits will be assigned to the member.
• If no signature of authorization from the member is present.

Non-assigned benefits payments to member of $2,500.00 or greater will defer for floor limit.  Refer to Corporate Administrative Medical Policy CAM165.

Assignment Conflicts
If a provider accepted assignment but the payment was sent to the member in error, a refund request will be initiated to the member.  The claim will not be reprocessed to pay the provider until the member refunds the overpayment.  If an inquiry is made by the provider regarding the payment, we will advise him/her that he/she must contact the member for payment. 

**When Corporate Audit identifies an assignment error of this type, it will not be reported as an error**  

However, if the provider is a contracting provider, his/her agreement will supersede the above and the assignment will be honored.

Exception:
Some ASO accounts may elect to have requirements that differ.  Deviations from the standard requirements described in this policy should be determined by the group representatives and documented in the departmental desk procedures.

Flipping of Assignment
Effective November 22, 2000 our corporate policy on paying non-participating providers changed.  We will not pay providers who do not participate in our Preferred Blue and Preferred Blue POS networks.     Some exceptions are listed in this policy.  These exceptions are subject to change without notice.

Exceptions:
Change ONLY applies to non-participating providers located in South Carolina. 

ASO groups will be given the option to participate in the change or not.

Comprehensive, Mohasco, State Group, and Group-Specific Networks (i.e. Tuomey Hospital Network, Self Memorial Hospital Network) will be excluded.

• Par National Accounts (group 60 and 70) will be excluded.  We pay according to the "pay to" indicator on the claim from the Home Plan.
• ITS Home/Host claims will be excluded.
• Routine mammography claims by category (02614) will be excluded.  Currently, if a member goes to a non-network mammography provider the claim is denied.
• Ambulance providers will be excluded by the provider speciality.  We do not offer an ambulance network.
• Group prefixes 83, 86, 88, 90, 91 and 92 will be excluded.  We have to follow Medicare’s assignment rules.
• Providers not participating in the Preferred Blue and Preferred Blue POS networks will flip assignment and pay the subscriber.  This applies to our Fully-Insured groups, excluding ITS claims.  These groups are identified with prefixes 02, 05, 06, 10, 15, 18, 25, 26, and 45.
• AX, AZ and PN networks should bypass the rules database logic because there is already logic that flips assignment based on flipping indicators set on the GCCF record.
• Non-Par RAP providers with a group that does participate in the flipping of assignment will pay the subscriber regardless of the GCCF record.
• Non-Par RAP providers with a group that does not participate in the flipping of assignment will follow the GCCF record and pay the provider.

Assignment on Prescription Drug Claims
Please refer to Policy CAM 114, Drug Claim Processing.