Testing requirements for all Institutional Provider Types
The list below represents a sampling of scenarios that may be required to certify. It will be acceptable to include multiple scenarios in a single claim.

• BCBSNE Subscriber as patient
• BCBSNE Dependent as patient
• BCBSNE Secondary

• One FEP Primary with Subscriber or Dependent as patient
• One FEP Secondary with Dependent as patient

• BCBSNE Primary and > 11 service lines
• BCBSNE Primary and > 1 ICD-9 diagnosis code and > 1 ICD-9 procedure code
• BCBSNE Primary and PWK at the claim level
• BCBSNE Primary and PWK at the service line level
• BCBSNE Primary and CPT-IV/HCPC code at the revenue code level
• BCBSNE Primary and outpatient surgery
• BCBSNE Primary and CPT modifier(s) on a service line
• BCBSNE Primary and Series billing for outpatient services
• BCBSNE Primary and > 1 payer
• BCBSNE Primary and One claim with narrative
• BCBSNE Primary and Revenue code with zero charge line
• BCBSNE Primary and Medical Record #
• BCBSNE Primary and one claim with Attending Physician populated
• BCBSNE Primary and at least two claims with different bill types
• BCBSNE Primary and at least one second or final interim claim
  

Specialty Services
(If you are a specialty provider, you must send one claim that meets the requirements below, in addition to the above.)

• BCBSNE Primary and Ambulance charges that include basic service and mileage
• BCBSNE Primary and Home Health nursing charges that include more than one date of service
• BCBSNE Primary and Hospice Services that include more than one date of service
• BCBSNE Primary and Skilled Nursing Facility charges
• BCBSNE Primary and per diem claim
• BCBSNE Primary and DRG claim
• BCBSNE Primary and Acute Care claim
• BCBSNE Primary and Work Related Injury claim
• BCBSNE Primary and Principal, Admitting, and E-code diagnosis on same claim
• BCBSNE Primary and Rehab Admission
• BCBSNE Primary and Psychiatric Admission or Partial Hospitalization